Federico Tomassini1, Yves D'Asseler2, Michael Linecker3, Mariano C Giglio4, Carlos Castro-Benitez5, Stéphanie Truant6, Rimma Axelsson7, Pim B Olthof8, Roberto Montalti9, Matteo Serenari10, Thiery Chapelle11, Valerio Lucidi12, Ernesto Sparrelid13, René Adam5, Thomas Van Gulik14, François-René Pruvot6, Pierre-Alain Clavien3, Dario Bruzzese15, Karen Geboes16, Roberto I Troisi17. 1. Department of Human Structure and Repair, Ghent University Faculty of Medicine, B-9000 Ghent, Belgium. 2. Department of Nuclear Medicine, Ghent University Hospital, C Heymanslaan 10, B-9000 Ghent, Belgium. 3. Swiss HPB Center, University Hospital Zurich, Switzerland. 4. Department of Clinical Medicine and Surgery, Federico II University Naples, Via S. Pansini 5, I-80131 Naples, Italy. 5. University Paris Sud, Unité INSERM 935, Paul Brousse University Hospital, F-94804 Villejuif, France. 6. Department of Digestive Surgery and Transplantation, Lille University Hospital, F-59037 Lille, France. 7. Karolinska University Hospital, Imaging and Function, Medical Radiation Physics and Nuclear Medicine, Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Radiology, Stockholm, Sweden. 8. Department of Surgery, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands. 9. Department of Clinical Medicine and Surgery, Federico II University Naples, Via S. Pansini 5, I-80131 Naples, Italy; Department of Public Health, Federico II University Naples, Via S. Pansini 5, I-80131 Naples, Italy. 10. Department of Medical and Surgical Sciences, University of Bologna, Italy. 11. Department of Hepatobiliary, Transplantation, and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium. 12. Department of Digestive Surgery, Unit of Hepato-Biliary Surgery and Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. 13. Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 14. Department of Surgery, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands. 15. Department of Public Health, Federico II University Naples, Via S. Pansini 5, I-80131 Naples, Italy. 16. Department of Gastroenterology-Digestive Oncology, Ghent University Hospital, C Heymanslaan 10, 9000 Ghent, Belgium. 17. Department of Human Structure and Repair, Ghent University Faculty of Medicine, B-9000 Ghent, Belgium; Department of Clinical Medicine and Surgery, Federico II University Naples, Via S. Pansini 5, I-80131 Naples, Italy. Electronic address: roberto.troisi@unina.it.
Abstract
BACKGROUND: Post hepatectomy liver failure (PHLF) after ALPPS has been related to the discrepancy between liver volume and function. Pre-operative hepatobiliary scintigraphy (HBS) can predict post-operative liver function and guide when it is safe to proceed with major hepatectomy. Aim of this study was to evaluate the role of HBS in predicting PHLF after ALPPS, defining a safe cut-off. METHODS: A multicenter retrospective study was approved by the ALPPS Registry. All patients selected for ALPPS between 2012 and 2018, were evaluated. Every patient underwent HBS during ALPPS evaluation. PHLF was reported according to ISGLS definition, considering grade B or C as clinically significant. RESULTS: 98 patients were included. Thirteen patients experienced PHLF grade B or C (14%) following ALPPS-2. The HBS and the daily gain in volume (KGRFLR) of the future liver remnant (FLR) were significantly lower in PHLF B and C (p = .004 and .041 respectively). ROC curves indicated safe cut-offs of 4.1%/day (AUC = 0.68) for KGRFLR, and of 2.7 %/min/m2 (AUC = 0.75) for HBSFLR. Multivariate analysis confirmed these cut-offs as variables predicting PHLF after ALPPS-2. CONCLUSION: Patients presenting a KGRFLR ≤4.1%/day and a HBSFLR ≤2.7%/min/m2 are at high risk of PHLF and their second stage should be re-discussed.
BACKGROUND: Post hepatectomy liver failure (PHLF) after ALPPS has been related to the discrepancy between liver volume and function. Pre-operative hepatobiliary scintigraphy (HBS) can predict post-operative liver function and guide when it is safe to proceed with major hepatectomy. Aim of this study was to evaluate the role of HBS in predicting PHLF after ALPPS, defining a safe cut-off. METHODS: A multicenter retrospective study was approved by the ALPPS Registry. All patients selected for ALPPS between 2012 and 2018, were evaluated. Every patient underwent HBS during ALPPS evaluation. PHLF was reported according to ISGLS definition, considering grade B or C as clinically significant. RESULTS: 98 patients were included. Thirteen patients experienced PHLF grade B or C (14%) following ALPPS-2. The HBS and the daily gain in volume (KGRFLR) of the future liver remnant (FLR) were significantly lower in PHLF B and C (p = .004 and .041 respectively). ROC curves indicated safe cut-offs of 4.1%/day (AUC = 0.68) for KGRFLR, and of 2.7 %/min/m2 (AUC = 0.75) for HBSFLR. Multivariate analysis confirmed these cut-offs as variables predicting PHLF after ALPPS-2. CONCLUSION:Patients presenting a KGRFLR ≤4.1%/day and a HBSFLR ≤2.7%/min/m2 are at high risk of PHLF and their second stage should be re-discussed.