The role of hepatobiliary scintigraphy combined with spect/ct in predicting severity of liver failure before major hepat
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ORIGINAL ARTICLE
The role of hepatobiliary scintigraphy combined with spect/ct in predicting severity of liver failure before major hepatectomy: a single‑center pilot study Matteo Serenari1,2 · Chiara Bonatti2 · Lucia Zanoni3 · Giuliano Peta4 · Elena Tabacchi3 · Alessandro Cucchetti2 · Matteo Ravaioli1,2 · Cinzia Pettinato5 · Alberto Bagni6 · Antonio Siniscalchi7 · Antonietta D’Errico6 · Rita Golfieri4 · Stefano Fanti3 · Matteo Cescon1,2 Received: 19 June 2020 / Accepted: 20 October 2020 © The Author(s) 2020
Abstract Hepatobiliary scintigraphy (HBS) has been demonstrated to predict post-hepatectomy liver failure (PHLF). However, existing cutoff values for future liver remnant function (FLR-F) were previously set according to the “50–50 criteria” PHLF definition. Methods of calculation and fields of application in liver surgery have changed in the meantime. The aim of this study was to demonstrate the role of HBS combined with single photon emission computed tomography (SPECT/CT) in predicting severity of PHLF, according to the International Study Group of Liver Surgery (ISGLS). All patients submitted to major hepatectomy with preoperative HBS-SPECT/CT between November 2016 and December 2019, were analyzed. Patients were resected according to hepatic volumetry. Receiver operating characteristic (ROC) curve analysis was performed to identify cutoffs of FLR function for predicting PHLF according to ISGLS definition and grading. Of the 38 patients enrolled, 26 were submitted to one-stage hepatectomy (living liver donors = 4) and 12 to two-stage procedures (portal vein embolization = 4, ALPPS = 8). Overall, 18 patients developed PHLF according to ISGLS criteria: 12 of grade A (no change in the patient’s clinical management) and 6 of grade B (change in clinical management). ROC analysis established increasingly higher cutoffs of FLR-F for predicting PHLF according to the “50–50 criteria”, ISGLS grade B and ISGLS grade A/B, respectively. HBS with SPECT/CT may help to assess severity of PHLF following major hepatectomy. Prospective multicenter trials are needed to confirm the effective role of HBS-SPECT/CT in liver surgery. Keywords Hepatectomy · Liver failure · Hepatobiliary scintigraphy · SPECT · Mebrofenin
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13304-020-00907-2) contains supplementary material, which is available to authorized users. * Matteo Serenari [email protected] 1
General Surgery and Transplantation Unit, Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, Bologna, Italy
Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
2
3
Nuclear Medicine Unit, Azienda Ospedaliera-Universitaria di Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
Post-hepatectomy liver failure (PHLF) represents one of the most feared complications by liver surgeons. PHLF occurs when the future liver remnant (FLR) is inadequate in
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