Tc‐99m mebrofenin hepatobiliary scintigraphy to assess future liver remnant function before major liver surgery
Héloïse Smet, David Martin, Emilie Uldry, Rafaël Duran, Raphael Girardet, Niklaus Schaefer, John O. Prior, Alban Denys, Nermin Halkic, Nicolas Demartines, Emmanuel Melloul- Oncology
- General Medicine
- Surgery
Abstract
Background and Objectives
Assessment of liver function is paramount before hepatectomy. This study aimed to assess future liver remnant function (FLR‐F) using hepatobiliary scintigraphy (HBS) and to compare it to FLR volume (FLR‐V) in the prediction of posthepatectomy liver failure (PHLF). The impact of volume and function gains were also assessed in patients undergoing portal vein embolization (PVE) or liver venous deprivation (LVD).
Methods
All consecutive patients undergoing major hepatectomy between 02/2018 and 09/2021 with preoperative HBS were included. FLR‐V was expressed as percentage of total liver volume and analyzed using preoperative computed tomography. FLR‐V and FLR‐F gains after embolization were expressed in percentage. Receiver operating characteristic analysis was performed to compare both methods in predicting PHLF.
Results
Thirty‐six patients were included. PVE and LVD were performed in 4 (11%) and 28 patients (78%), respectively. Overall, PHLF occurred in eight patients (22%). FLR‐F gain after embolization showed significant ability to predict PHLF (area under the curve [AUC] = 0.789), with cut‐off value of 150% showing a sensitivity of 1.00, a specificity of 0.42, and a negative predictive value of 1.00.
Conclusion
Preoperative HBS shows a high sensitivity to predict PHLF when HBS is performed twice to measure the function gain after venous embolization.