Nonsuperiority of technetium-99m-galactosyl human serum albumin scintigraphy over conventional volumetry for assessing the future liver remnant in patients undergoing hepatectomy after portal vein embolization
Nonsuperiority of technetium-99m-galactosyl human serum albumin scintigraphy over conventional volumetry for assessing the future liver remnant in patients undergoing hepatectomy after portal vein embolization
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DOI：
10.1016/j.surg.2022.10.005
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发表时间：
2023-01-28
期刊：
影响因子：
3.8
通讯作者：
Hatano，Etsuro
中科院分区：
文献类型：
--
作者：
Yao，Siyuan;Taura，Kojiro;Hatano，Etsuro
背景锝-99 m-galactosyl人血清白蛋白容积显像是评价肝切除术后患者肝脏储备功能的首选方法，但其优于门静脉栓塞和随后的肝切除术后的计算机断层扫描容积测定的优越性仍不清楚。我们的目的是比较锝-99 m-半乳糖基人血清白蛋白荧光造影与传统的计算机断层扫描体积测定法预测术后肝切除术肝衰竭的患者门静脉embolization. Methods这项回顾性研究分析了152个连续的患者谁接受了肝胆癌切除术后门静脉栓塞2006年和2021年之间。根据国际肝脏外科研究组的标准对切除术后肝功能衰竭进行分级。结果门静脉栓塞后99 mTc-Galactosyl人血清白蛋白显像的残余肝摄取率（%）明显高于门静脉栓塞后的残余肝体积（%）（47.9% vs 40.8%;P<0.001），而门静脉栓塞前的数值相当（32.7% vs 31.2%;P= 0.116）。受试者工作特征曲线分析显示，门静脉栓塞后未来残留量（%）的曲线下面积显著高于门静脉栓塞后未来残留摄取（%）（0.709 vs 0.630;P= 0.046），用于预测切除术后肝功能衰竭。多变量分析显示，门静脉栓塞后的未来残留量（%）独立预测切除术后肝功能衰竭，但未来残留摄取（%）没有。尽管当基于未来残留体积（%）和未来残留摄取（%）的未来肝脏残留物的吲哚菁绿清除率≥0.05时，术后肝功能衰竭≥B级的发生率为17.8%，但在其他组合中，该发生率更高：残留体积的吲哚菁绿色清除率≥0.05/残留摄取的吲哚菁绿色清除率≤0.05时为55.6%;吲哚菁绿色清除率≤0.05/吲哚菁绿色清除率≥0.05; 50%为吲哚菁绿色清除的残留量≤0.05/吲哚菁绿色清除的残留量≤ 0.05。半乳糖基人血清白蛋白容积显像在评估门静脉后肝切除术后肝残留方面并不优于计算机断层扫描容积测定法（上级）静脉栓塞
BackgroundTechnetium-99m-galactosyl human serum albumin scintigraphy is preferred for assessing the liver functional reserve in patients undergoing hepatectomy, but its superiority over computed tomography volumetry after portal vein embolization and subsequent hepatectomy remains elusive. We aimed to compare technetium-99m-galactosyl human serum albumin scintigraphy with conventional computed tomography volumetry for predicting posthepatectomy liver failure in patients after portal vein embolization.MethodsThis retrospective study analyzed 152 consecutive patients who underwent hepatobiliary cancer resection after portal vein embolization between 2006 and 2021. Posthepatectomy liver failure was graded according to the International Study Group of Liver Surgery criteria. The predictive abilities for posthepatectomy liver failure were compared between the future remnant uptake (%) by technetium-99m-galactosyl human serum albumin scintigraphy and the future remnant volume (%) by computed tomography volumetry.ResultsFuture remnant uptake (%) was significantly greater than future remnant volume (%) after portal vein embolization (47.9% vs 40.8%;P< .001), while the values were comparable before portal vein embolization (32.7% vs 31.2%;P= .116). Receiver operating characteristic curve analysis revealed that post–portal vein embolization future remnant volume (%) had a significantly higher area under the curve than post–portal vein embolization future remnant uptake (%) (0.709 vs 0.630;P= .046) for predicting posthepatectomy liver failure. Multivariable analysis revealed that post–portal vein embolization future remnant volume (%) independently predicted posthepatectomy liver failure, but future remnant uptake (%) did not. Although the incidence of posthepatectomy liver failure grade ≥B was 17.8% when indocyanine green–clearance of the future liver remnant based on both future remnant volume (%) and future remnant uptake (%) was ≥0.05, it was higher in other combinations: 55.6% for indocyanine green clearance of the remnant volume ≥0.05/indocyanine green clearance of the remnant uptake ≤0.05; 50.0% for indocyanine green clearance of the remnant volume ≤0.05/indocyanine green clearance of the remnant uptake ≥0.05; and 50% for indocyanine green clearance of the remnant volume ≤0.05/indocyanine green clearance of the remnant uptake ≤0.05.ConclusionsTechnetium-99m-galactosyl human serum albumin scintigraphy is not superior to computed tomography volumetry for assessing the future liver remnant in patients undergoing major hepatectomy after portal vein embolization.