Pim B Olthof1, Robert J S Coelen2, Roelof J Bennink3, Michal Heger2, Meng F Lam3, Marc G Besselink2, Olivier R Busch2, Krijn P van Lienden4, Thomas M van Gulik2. 1. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: p.b.olthof@amc.nl. 2. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 4. Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Posthepatectomy liver failure (PHLF) is a threatening complication after liver surgery, especially in perihilar cholangiocarcinoma (PHC). This study aimed to assess the value of preoperative assessment of liver function using 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) to predict PHLF in comparison with liver volume in PHC patients. METHODS: All patients who underwent resection of suspected PHC in a single center between 2000 and 2015 were included in the analysis. PHLF was graded according to the ISGLS criteria with grade B/C considered clinically relevant. A cut-off value for the prediction of PHLF was calculated using the receiver operating characteristic curve (ROC) analysis. RESULTS: A total of 116 patients were included of which 27 (23%) suffered of PHLF. ROC values for the prediction of PHLF were 0.74 (0.63-0.86) for future liver remnant function and 0.63 (0.47-0.80) for volume. A cut-off for liver function was set at 8.5%/min, which resulted in a negative predictive value of 94% and positive predictive value of 41%. CONCLUSIONS: Assessment of liver function with HBS had better predictive value for PHLF than liver volume in patients undergoing major liver resection for suspected PHC. The cut-off of 8.5%/min can help to select patients for portal vein embolization and might help to reduce postoperative liver failure.
BACKGROUND: Posthepatectomy liver failure (PHLF) is a threatening complication after liver surgery, especially in perihilar cholangiocarcinoma (PHC). This study aimed to assess the value of preoperative assessment of liver function using 99mTc-mebrofeninhepatobiliary scintigraphy (HBS) to predict PHLF in comparison with liver volume in PHC patients. METHODS: All patients who underwent resection of suspected PHC in a single center between 2000 and 2015 were included in the analysis. PHLF was graded according to the ISGLS criteria with grade B/C considered clinically relevant. A cut-off value for the prediction of PHLF was calculated using the receiver operating characteristic curve (ROC) analysis. RESULTS: A total of 116 patients were included of which 27 (23%) suffered of PHLF. ROC values for the prediction of PHLF were 0.74 (0.63-0.86) for future liver remnant function and 0.63 (0.47-0.80) for volume. A cut-off for liver function was set at 8.5%/min, which resulted in a negative predictive value of 94% and positive predictive value of 41%. CONCLUSIONS: Assessment of liver function with HBS had better predictive value for PHLF than liver volume in patients undergoing major liver resection for suspected PHC. The cut-off of 8.5%/min can help to select patients for portal vein embolization and might help to reduce postoperative liver failure.
Authors: Lynn E Nooijen; Rutger-Jan Swijnenburg; Heinz-Josef Klümpen; Joanne Verheij; Geert Kazemier; Thomas M van Gulik; Joris I Erdmann Journal: Visc Med Date: 2021-01-07
Authors: Pim B Olthof; Luca Aldrighetti; Ruslan Alikhanov; Matteo Cescon; Bas Groot Koerkamp; William R Jarnagin; Silvio Nadalin; Johann Pratschke; Moritz Schmelze; Ernesto Sparrelid; Hauke Lang; Alfredo Guglielmi; Thomas M van Gulik Journal: Ann Surg Oncol Date: 2020-02-26 Impact factor: 5.344