• Hepatectomy
• Hepatocyte
• Liver failure
• Liver function
• Metabolic activity
• Volumetry
• [99mTc]Tc-mebrofenin

• Humans
• Male
• Female
• Middle Aged
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Imino Acids
• Organotechnetium Compounds
• Aged
• Single Photon Emission Computed Tomography Computed Tomography/methods
• Prospective Studies
• Liver Neoplasms/surgery
• Liver Neoplasms/diagnostic imaging
• Liver/diagnostic imaging
• Liver/surgery
• Glycine
• Aniline Compounds
• Adult
• Radiopharmaceuticals
• Liver Failure/diagnostic imaging
• Liver Failure/etiology
• Preoperative Care

• Future remnant liver volume
• Liver function reserve
• Major hepatectomy
• Platelet
• Post-hepatectomy liver failure

• Humans
• Hepatectomy/adverse effects
• Platelet Count
• Liver Neoplasms/surgery
• Liver Failure/diagnosis
• Liver Failure/etiology
• Liver Failure/surgery
• Postoperative Complications/etiology
• Retrospective Studies
• Carcinoma, Hepatocellular/surgery

Performing major hepatectomy for patients with marginal hepatic function is challenging. In some cases, the procedure is contraindicated owing to the threat of postoperative liver failure. In this case report, we present the first case of marginal liver function (indocyanine green clearance retention rate at 15 min [ICGR15]: 28%) successfully treated with right hepatectomy, resulting in total caudate lobe preservation.

A 71-year-old man was diagnosed with sigmoid colon cancer with three liver metastases (S5, S7, and S8). All of metastatic lesions shrunk after chemotherapy, but his ICGR15 and indocyanine green clearance rate (ICGK) were 21% and 0.12, respectively. Moreover, the remnant liver volume was only 39%. Therefore, portal venous embolism (PVE) of the right portal vein was suggested. Portography showed divergence of the considerably preserved right caudate lobe branch (PV1R) from the root of the right portal vein. The liver function was reevaluated 18 days after PVE was suggested. During this time, the ICGR15 (21–28%) and ICGK rate (0.12–0.10) deteriorated. The right caudate lobe was significantly enlarged; thus, a total caudate lobe-preserving hepatectomy (TCPRx) was performed. Patients eligible for TCPRx included those with (1) hepatocellular carcinoma or metastatic liver cancer, (2) no tumor in the caudate lobe, (3) marginal liver function (ICG Krem greater than 0.05 if TCPRx was adapted; otherwise, less than 0.05) and Child–Pugh classification category A, and (4) preserved PV1R and right caudate bile duct branch. The procedure was performed through (A) precise estimation of the remnant liver volume preoperatively, (B) repeated intraoperative cholangiography to confirm the biliary branch of the right caudate lobe (B1R) conservation, and (C) stapler division of posterior and anterior Glisson’s pedicles laterally to avoid injuries to the PV1R and B1R.

Right hepatectomy with total caudate lobe preservation, following PVE, was a safe and viable surgical technique for patients with marginal liver function.

• Liver function
• Preservation of caudate lobe
• Right hepatectomy

Although volumetric imaging by computed tomography (CT) is the gold standard for preoperative assessment of the future liver remnant, nuclear imaging studies have shown promising data. This systematic review summarized the results from trials investigating volumetric and nuclear medicine imaging for the prediction of postoperative mortality and liver failure (LF).

MEDLINE and Web of Science were searched for papers investigating nuclear imaging methods for the prediction of postoperative clinical outcomes in patients undergoing local, liver-directed treatments. Only papers investigating both preoperative nuclear imaging and CT or magnetic resonance imaging (MR) for the prediction of postoperative mortality and/or LF were included.

Twenty-five trials were qualified for this review. All trials but two used technetium-based tracers for the nuclear imaging examination. Four papers used MR imaging and the remaining used CT for the volumetric evaluation. Overall, the studies were heterogeneous both in terms of methodology and imaging technique. Of the thirteen studies reporting on postoperative mortality, most were descriptive without detailed diagnostic data. A few with detailed data found that nuclear imaging had better predictive value than volumetric imaging. Nineteen studies investigated the prediction of postoperative LF of which seven papers investigated the predictive value of both modalities in multivariable regression analysis. Two papers found that only nuclear imaging parameters were predictive of LF, one paper found that the CT parameter was predictive, and four papers found that combined nuclear and CT/MR imaging parameters were predictive of LF.

Both methodologies were useful in the preoperative assessment of patients scheduled for liver interventions, especially in combination, but nuclear imaging demonstrated better predictive value for postoperative mortality and LF in a few trials. The overall technical and methodological heterogeneity of the included studies complicates the ability to directly compare the clinical utility of the two imaging techniques.

• Future liver remnant
• Liver failure
• Liver function
• Liver volume
• Mortality
• Nuclear imaging
• Preoperative assessment

• hepatocellular carcinoma
• oncological benefit
• portal vein embolization
• portal vein ligation

Several nuclear imaging methods may predict postoperative liver function and outcome, but none has achieved recommendations in clinical guidelines. The purpose of this systematic review was to summarize the existing knowledge on this topic.

MEDLINE and Web of Science were searched for studies investigating nuclear medicine imaging methods for the prediction of postoperative liver function in patients undergoing localized, liver-directed treatments. The postoperative endpoints were clinical outcome (morbidity and mortality) as well as measures of postoperative liver function, e.g., liver function assessed by biochemical tests or nuclear imaging.

A total of 1352 references were identified, of which 82 fulfilled the eligibility criteria and were included in the review. Most studies (n = 63) were retrospective studies. The vast majority of studies assessed [^99mTc]Tc-galactosyl serum albumin (GSA) (n = 57) and [^99mTc]Tc-mebrofenin (n = 19). Liver resection was entirely or partly major (involved at least three segments) in 78 reports. There were notable variations in the research methodology, e.g., image acquisition, imaging variables, and endpoints. Thirty-seven studies reported on postoperative mortality, of which most reported descriptive data at the patient level. Of the four reports that performed multivariate analyses, two showed significant predictive results of isotope-based preoperative tests. Fifty-two papers presented data on postoperative liver failure. Multivariate predictive analyses were performed in eighteen trials, of which fifteen showed the significant value of nuclear medicine tests.

There is sparse evidence supporting the significant value of nuclear medicine imaging methods in predicting postoperative mortality. In contrast, a notable number of trials showed a significant prediction of liver failure in multivariate analyses. The research methodology was heterogeneous and exploratory in most trials. Documentation of nuclear medicine tests in this setting awaits the results of properly designed, prospective trials with the standardization of both the nuclear medicine test and endpoints.

• Liver failure
• Liver function
• Liver nuclear imaging
• Liver resection
• Mortality

• Liver fibrosis
• New Inuyama classification
• PD-L1

• Hepatectomy
• Humans
• Liver Failure/etiology
• Liver Function Tests
• Platelet Count
• Postoperative Complications/etiology
• Predictive Value of Tests
• Risk Factors
• Thrombocytopenia/complications

• alpha-fetoprotein
• des-γ -carboxy prothrombin
• half-life time
• hepatectomy
• tumor marker

Assessment of hepatic functional reserve is important to enable the selection of appropriate treatment methods and safe hepatic resection in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). In the present study, an evaluation was made of the clinical value of combining the Child-Pugh score (CPS) with the standardized future liver remnant (sFLR) measurement to predict postoperative liver dysfunction (PLD). A total of 61 HBV-related HCC patients undergoing liver volumetry prior to hepatectomy were enrolled in the study. The sFLR was calculated as the ratio of FLR volume to standardized liver volume. PLD was defined as a prothrombin time of >18 sec or a peak serum bilirubin level of >51.3 µmol/l for 7 days after surgery. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors associated with PLD. The correlation between PLD and the combination of sFLR and CPS was analyzed. In total, 18 out of 61 patients developed PLD (29.5%), with a significantly higher PLD incidence for a CPS of 6 than a CPS of 5 (P<0.05). Multivariate logistic regression analysis revealed that a prothrombin time of <13.3 sec and an sFLR of <0.55 were independent risk factors for PLD. Receiver operating characteristic (ROC) curve analysis revealed that the cut-off values of sFLR and sFLR/CPS for predicting PLD were 54.5% and 0.0916, respectively, with areas under the ROC curve of 0.820 and 0.860, respectively. The combination of CPS and sFLR appears to yield improved prediction of the occurrence of PLD compared with either CPS or sFLR alone.

• Child-Pugh score
• future liver remnant
• hepatectomy
• hepatocellular carcinoma
• postoperative liver dysfunction

• Anatomic segmentectomy
• Hepatocellular carcinoma
• Liver volume
• Respectability

• ablation therapy
• hepatocellular carcinoma
• pathological vascular invasion

• Branched-chain amino acids
• Functional liver regeneration
• Liver uptake value
• Major hepatectomy
• Portal vein embolization

• Biliary Fistula/etiology
• Biliary Fistula/prevention & control
• Biliary Fistula/therapy
• Combined Modality Therapy
• Hepatectomy/methods
• Humans
• Liver Diseases/surgery
• Minimally Invasive Surgical Procedures/methods
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Postoperative Complications/therapy
• Postoperative Hemorrhage/etiology
• Postoperative Hemorrhage/prevention & control
• Postoperative Hemorrhage/therapy
• Reoperation

• Adult
• Aged
• Aged, 80 and over
• Blood Transfusion/statistics & numerical data
• Body Mass Index
• Coloring Agents/metabolism
• Female
• Hemorrhage/epidemiology
• Hepatectomy
• Humans
• Indocyanine Green/metabolism
• International Normalized Ratio
• Liver Failure/diagnosis
• Liver Failure/mortality
• Liver Function Tests
• Liver Neoplasms/physiopathology
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Operative Time
• Organ Size
• Predictive Value of Tests
• Risk Factors
• Sensitivity and Specificity

• Ascites
• Hepatectomy
• Methicillin-resistant staphylococci

• Adult
• Aged
• Aged, 80 and over
• Ascites/epidemiology
• Ascites/etiology
• Female
• Follow-Up Studies
• Hepatectomy/adverse effects
• Humans
• Incidence
• Japan/epidemiology
• Male
• Methicillin-Resistant Staphylococcus aureus/isolation & purification
• Middle Aged
• Prognosis
• Retrospective Studies
• Staphylococcal Infections/complications
• Staphylococcal Infections/epidemiology
• Staphylococcal Infections/microbiology
• Surgical Wound Infection/complications
• Surgical Wound Infection/epidemiology
• Surgical Wound Infection/microbiology
• Survival Rate/trends

AIM: To report the devised anatomic liver resection of segments 6, 7 and 8 to improve the resection rate for patients with right liver tumors.

METHODS: We performed anatomic liver resection of segments 6, 7 and 8 to guarantee the maximum preservation of the remaining normal liver tissue. Segment 5 was determined by two steps of Glissonean pedicle occlusion. And a “┏┛” shaped broken resection line was marked upon the diaphragmatic surface of the liver. Selective right hemihepatic inflow occlusion was used to reduce blood loss during parenchymal transection between segments 6 and 5 and between segments 8 and 5. If needed, total hepatic Glissonean pedicle occlusion was used during parenchymal transection between segment 8 and the left liver.

RESULTS: Compared to right hemihepatectomy, the percentage of future liver remnant volume was increased by an average of 13.9% if resection of segments 6, 7 and 8 was performed. Resection of segments 6, 7 and 8 was completed uneventfully. After hepatectomy, the inflow and outflow of segment 5 were maintained. There was no perioperative mortality, postoperative abdominal bleeding or bile leakage in this group. Alpha-fetoprotein (AFP) returned to the normal range within 2 mo after the operation in all the patients. One patient died 383 d postoperatively due to obstructive suppurative cholangitis. One patient suffered from severe liver dysfunction shortly after surgery and had intrahepatic recurrence 4 mo postoperatively. Postoperative lung metastasis was found in one patient. No tumor recurrence was found in the other patients and the parameters including liver function and AFP level were in the normal range.

CONCLUSION: Anatomic liver resection of segments 6, 7 and 8 can be a conventional operation to improve the overall resection rate for hepatocellular carcinoma.

• Anatomic hepatectomy
• Hepatocellular carcinoma
• Selective occlusion
• Alpha-fetoprotein
• Liver tumor

• Adult
• Carcinoma, Hepatocellular/surgery
• Hepatectomy
• Humans
• Liver/surgery
• Liver Diseases/etiology
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Postoperative Period
• Tomography, X-Ray Computed