Functional hepatic regeneration following hepatectomy using galactosyl-human serum albumin liver scintigraphy
Section snippets
Clinical materials
The 32 patients included 20 hepatocellular carcinomas; six cholangiocarcinomas; four metastatic cancers; and two benign tumors. Twenty-two disegmentectomy and 10 trisegmentectomy procedures were performed. The mean age of the patients was 61 years, with a range of 49 to 71 years. There were 24 (75%) male and 8 (25%) female patients. Child's classification showed that 27 cases were Child A, and 5, Child B. The patients were then divided into two groups: normal liver (NOR) without chronic
Results
The preoperative GSA-LV values significantly correlated with hepatocyte volume, the ICGR15, and conventional liver function tests, such as aspartate aminotransferase, total protein, γ-glutamyl transpeptidase, γ-globulin, and activated partial thromboplastin time. Similarly, hepatocyte volume correlated with the CT-LV, the ICGR15, γ-globulin, prothrombin time, activated partial thromboplastin time, and the hepaplastin test. However, the CT-LV only correlated with the ICGR15. The preoperative
Discussion
Liver volume measurements obtained from computed tomograms have been used to extrapolate liver function.1, 2 However, liver volume measurements (CT-LV) obtained from our patients did not correlate with conventional indices of liver function, with the exception of the ICG test. The total hepatocyte volume significantly correlated with many parameters of liver function; higher correlation coefficients were demonstrated with this measurement than with the total liver volume. These results suggest
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Cited by (24)
Asymmetric kinetics of volume and function of the remnant liver after major hepatectomy as a key for postoperative outcome - A case-matched study
2020, HPBCitation Excerpt :While most of the volumetric regeneration takes place during the first week post-hepatectomy,14,16 functional status of the regenerating liver has remained unclear so far, except for the previously-described impact of regeneration on ICG17,18 or drugs19 clearance or bilirubin excretion,2 especially after MH.20,21 Though the relevance of HBS during the liver regeneration process has been established,6,22,23 no definitive conclusions could be drawn from the few clinical reports on post-hepatectomy HBS due to small and heterogeneous study populations, including hepatitis or cirrhosis, or minor hepatectomies with expectedly-low regeneration rates, and absence of SPECT.6,24–26 By contrast, the current study was specifically designed to analyze post-hepatectomy changes in RL function through a standardized protocol, focusing on major hepatectomy with a median of 4 resected segments in noncirrhotic patients in order to obtain a significant liver regeneration rate.27
Systematic review of pathophysiological changes following hepatic resection
2014, HPBCitation Excerpt :Nagino et al. found a poor correlation between regeneration measured by CT volumetry and postoperative liver dysfunction.79 Liver volume may not accurately reflect the quantity of hepatocytes, especially in cirrhotic livers.80 Galactosyl-human serum albumin scintigraphy (GSA) is a method of estimating functional liver mass and was compared with CT liver volume in 32 patients undergoing liver resection.80
Preoperative evaluation of liver function
2017, Extreme Hepatic Surgery and Other Strategies: Increasing Resectability in Colorectal Liver Metastases