Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS: a multi-institutional study.,HPB

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Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS: a multi-institutional study.
HPB ( IF 2.9 ) Pub Date : 2020-02-10 , DOI: 10.1016/j.hpb.2020.01.010
Federico Tomassini ₁ , Yves D'Asseler ₂ , Michael Linecker ₃ , Mariano C Giglio ₄ , Carlos Castro-Benitez ₅ , Stéphanie Truant ₆ , Rimma Axelsson ₇ , Pim B Olthof ₈ , Roberto Montalti ₉ , Matteo Serenari ₁₀ , Thiery Chapelle ₁₁ , Valerio Lucidi ₁₂ , Ernesto Sparrelid ₁₃ , René Adam ₅ , Thomas Van Gulik ₁₄ , François-René Pruvot ₆ , Pierre-Alain Clavien ₃ , Dario Bruzzese ₁₅ , Karen Geboes ₁₆ , Roberto I Troisi ₁₇

Affiliation

Department of Human Structure and Repair, Ghent University Faculty of Medicine, B-9000 Ghent, Belgium.
Department of Nuclear Medicine, Ghent University Hospital, C Heymanslaan 10, B-9000 Ghent, Belgium.
Swiss HPB Center, University Hospital Zurich, Switzerland.
Department of Clinical Medicine and Surgery, Federico II University Naples, Via S. Pansini 5, I-80131 Naples, Italy.
University Paris Sud, Unité INSERM 935, Paul Brousse University Hospital, F-94804 Villejuif, France.
Department of Digestive Surgery and Transplantation, Lille University Hospital, F-59037 Lille, France.
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.
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.
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.
Department of Medical and Surgical Sciences, University of Bologna, Italy.
Department of Hepatobiliary, Transplantation, and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium.
Department of Digestive Surgery, Unit of Hepato-Biliary Surgery and Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Surgery, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Public Health, Federico II University Naples, Via S. Pansini 5, I-80131 Naples, Italy.
Department of Gastroenterology-Digestive Oncology, Ghent University Hospital, C Heymanslaan 10, 9000 Ghent, Belgium.
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.

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 (KGR_FLR) 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 KGR_FLR, and of 2.7 %/min/m² (AUC = 0.75) for HBS_FLR. Multivariate analysis confirmed these cut-offs as variables predicting PHLF after ALPPS-2.

Conclusion

Patients presenting a KGR_FLR ≤4.1%/day and a HBS_FLR ≤2.7%/min/m² are at high risk of PHLF and their second stage should be re-discussed.

中文翻译：

肝胆显像和动态增长率预测 ALPPS 后的肝功能衰竭：一项多机构研究。

背景

ALPPS 后肝切除术后肝功能衰竭 (PHLF) 与肝体积和功能之间的差异有关。术前肝胆显像 (HBS) 可以预测术后肝功能并指导何时进行大肝切除术是安全的。本研究的目的是评估 HBS 在预测 ALPPS 后 PHLF 中的作用，确定安全截止值。

方法

ALPPS Registry 批准了一项多中心回顾性研究。评估了 2012 年至 2018 年间为 ALPPS 选择的所有患者。每个患者在 ALPPS 评估期间都接受了 HBS。根据 ISGLS 定义报告 PHLF，将 B 或 C 级视为具有临床意义。

结果

包括 98 名患者。13 名患者在 ALPPS-2 后经历了 PHLF B 或 C 级（14%）。PHLF B 和 C 中未来残余肝脏 (FLR)的 HBS 和每日体积增加 (KGR _FLR ) 显着降低（分别为p = .004 和 .041）。ROC 曲线表明 KGR _{FLR 的}安全截止值为 4.1%/天 (AUC = 0.68 )，HBS _{FLR 的}安全截止值为 2.7%/min/m ² (AUC = 0.75) 。多变量分析证实这些临界值是预测 ALPPS-2 后 PHLF 的变量。