Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2016; 22(17): 4373-4379
Published online May 7, 2016. doi: 10.3748/wjg.v22.i17.4373
Significance of functional hepatic resection rate calculated using 3D CT/99mTc-galactosyl human serum albumin single-photon emission computed tomography fusion imaging
Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi
Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
Author contributions: All authors substantially contributed to data acquisition, analysis, and interpretation; Tsuruga Y drafted the manuscript; Kamiyama T revised the manuscript for important intellectual content; Taketomi A gave final approval of the version to be published.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Hokkaido University Hospital for Clinical Research.
Informed consent statement: Patients were not required to give informed consent because the analysis used anonymous clinical data. For full disclosure, the details of the study are published on the home page of Hokkaido University Hospital.
Conflict-of-interest statement: The authors have no potential conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yosuke Tsuruga, MD, PhD, Specially Appointed Assistant Professor, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan. ytsuruga@med.hokudai.ac.jp
Telephone: +81-11-7065927 Fax: +81-11-7177515
Received: December 28, 2015
Peer-review started: December 28, 2015
First decision: January 28, 2016
Revised: February 11, 2016
Accepted: March 2, 2016
Article in press: March 2, 2016
Published online: May 7, 2016
Processing time: 123 Days and 10.1 Hours
Abstract

AIM: To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/99mTc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making.

METHODS: We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and 99mTc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/99mTc-GSA SPECT fusion images.

RESULTS: In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death.

CONCLUSION: Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 mL.

Keywords: 99mTc-galactosyl human serum albumin; Single-photon emission computed tomography; Hepatectomy; Functional hepatic resection rate; Parenchymal hepatic resection rate

Core tip: We evaluated the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/99mTc-galactosyl human serum albumin (GSA) single-photon emission computed tomography fusion imaging and found a strong correlation between FHRR and the parenchymal hepatic resection rate (PHRR). However, FHRR and PHRR were discrepant because of insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, or a tumor volume of > 1000 mL.