technetium-tc-99m-mebrofenin and Klatskin-Tumor

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. 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.. 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%.. 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.

Topics: Aged; Aniline Compounds; Area Under Curve; Bile Duct Neoplasms; Female; Glycine; Hepatectomy; Humans; Imino Acids; Klatskin Tumor; Liver Failure; Liver Function Tests; Male; Middle Aged; Neoplasm Grading; Netherlands; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Risk Factors; ROC Curve; Single Photon Emission Computed Tomography Computed Tomography; Treatment Outcome

The aim of this study was to assess the safety and efficacy of extended liver venous deprivation (eLVD), i.e. combination of right portal vein embolisation and right (accessory right) and middle hepatic vein embolisation before major hepatectomy for future remnant liver (FRL) functional increase.. eLVD was performed in non-cirrhotic patients referred for major hepatectomy in a context of small FRL (baseline FRL <25% of the total liver volume or FRL function <2.69%/min/m. Ten consecutive patients underwent eLVD before surgery for liver metastases (n = 8), Klatskin tumour (n = 1) and gallbladder carcinoma (n = 1). FRL function increased by 64.3% (range = 28.1-107.5%) at day 21. In patients with serial measurements, maximum FRL function was at day 7 (+65.7 ± 16%). The FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day). Thirty-one days (range = 22-45 days) after eLVD, 9/10 patients were resected. No post-hepatectomy liver failure was reported. Two grade II and one grade III complications (Dindo-Clavien classification) occurred. No patient died with-in 90 days following surgery.. eLVD is safe and provides a marked and very rapid increase in liver function, unprecedented for an interventional radiology procedure.. • eLVD is safe • eLVD provides a marked and very rapid increase in liver function • After eLVD, the FRL-F increased by 64.3% (28.1-107.5%) at day 21 • After eLVD, the maximum FRL-F was obtained at day 7 (+65.7 ± 16%) • After eLVD, the FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day).

Topics: Aged; Aniline Compounds; Bile Duct Neoplasms; Embolization, Therapeutic; Female; Gallbladder Neoplasms; Glycine; Hepatectomy; Hepatic Veins; Humans; Imino Acids; Klatskin Tumor; Liver; Liver Failure; Liver Function Tests; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Portal Vein; Preoperative Care; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Tomography, X-Ray Computed