TY - JOUR
T1 - Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS: a multi-institutional study
AU - Tomassini, Federico
AU - D'Asseler, Yves
AU - Linecker, Michael
AU - Giglio, Mariano C.
AU - Castro-Benitez, Carlos
AU - Truant, Stéphanie
AU - Axelsson, Rimma
AU - Olthof, Pim B.
AU - Montalti, Roberto
AU - Serenari, Matteo
AU - Chapelle, Thiery
AU - Lucidi, Valerio
AU - Sparrelid, Ernesto
AU - Adam, René
AU - van Gulik, Thomas
AU - Pruvot, François-René
AU - Clavien, Pierre-Alain
AU - Bruzzese, Dario
AU - Geboes, Karen
AU - Troisi, Roberto I.
PY - 2020/10
Y1 - 2020/10
N2 - 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 (KGRFLR) 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 KGRFLR, and of 2.7 %/min/m2 (AUC = 0.75) for HBSFLR. Multivariate analysis confirmed these cut-offs as variables predicting PHLF after ALPPS-2. Conclusion: Patients presenting a KGRFLR ≤4.1%/day and a HBSFLR ≤2.7%/min/m2 are at high risk of PHLF and their second stage should be re-discussed.
AB - 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 (KGRFLR) 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 KGRFLR, and of 2.7 %/min/m2 (AUC = 0.75) for HBSFLR. Multivariate analysis confirmed these cut-offs as variables predicting PHLF after ALPPS-2. Conclusion: Patients presenting a KGRFLR ≤4.1%/day and a HBSFLR ≤2.7%/min/m2 are at high risk of PHLF and their second stage should be re-discussed.
UR - http://www.scopus.com/inward/record.url?scp=85079158773&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.hpb.2020.01.010
DO - https://doi.org/10.1016/j.hpb.2020.01.010
M3 - Article
C2 - 32057681
SN - 1365-182X
VL - 22
SP - 1420
EP - 1428
JO - HPB: The official journal of the International Hepato Pancreato Biliary Association
JF - HPB: The official journal of the International Hepato Pancreato Biliary Association
IS - 10
ER -