Comparing 99mTc-mebrofenin scintigraphy and LiMAx-Test to assess presurgical functional liver capacitiy before major liver resection

Introduction:

Posthepatectomy liver failure (PHLF) is still a severe problem after major liver resection (≥4segments) and remains a major cause of perioperative morbidity and mortality. Due to advances in chemotherapy, surgical techniques, perioperative management and high-qualitiy imaging more complex procedures are possible. LiMAx-Test and 99mTc-Mebrofenin scintigraphy are approved methods for preoperative assessment of liver function and feasible in the clinical routine.

Methods:

We performed a full presurgical assessment before major liver resections because of hepatibiliary malignancies. We analyzed the impact of liver function on postoperative outcome including PHLF (50 – 50 criteria, Peak-Bili-7, ISGLS-criteria) and morbidity (Dindo-Clavien Classification).

Results:

PHLF occured in 10 of 30 patients (all definitions). 6 of 10 patients with PHLF showed preoperative critical 99mTc-Mebrofenin scintigraphy levels (cut-off: < 2.69%/min/m² uptake rate). 4 of 10 patients with PHLF were detected by presurgical LiMAx-Test (cut-off:< 100 µg/h/kg). Level IIIb complications according to the modified Clavien-Dindo classification occured in 7patients.

Conclusion:

99mTc-mebrofenin scintigraphy and LiMAx can be helpful tools to evaluate the functional liver remnant and to support the decision to indicate surgery. So far, no clear trend towards superiority of either method can be detected. Expansion of the study group is warrented to get more reliable information.