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Eur J Surg Oncol. 2017 Dec;43(12):2277-2284. doi: 10.1016/j.ejso.2017.08.009. Epub 2017 Sep 4.

Estimation of the future remnant liver function is a better tool to predict post-hepatectomy liver failure than platelet-based liver scores.

Author information

1
Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, 2650 Edegem, Belgium. Electronic address: Thiery.Chapelle@uza.be.
2
Department of Radiology, Antwerp University Hospital, 2650 Edegem, Belgium. Electronic address: Bart.OpdeBeeck@uza.be.
3
Department of Pathology, Antwerp University Hospital, 2650 Edegem, Belgium. Electronic address: Ann.Driessen@uza.be.
4
Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, 2650 Edegem, Belgium. Electronic address: Geert.Roeyen@uza.be.
5
Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, 2650 Edegem, Belgium. Electronic address: Bart.Bracke@uza.be.
6
Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, 2650 Edegem, Belgium. Electronic address: Vera.Hartmann@uza.be.
7
Department of Nuclear Medicine, Antwerp University Hospital, 2650 Edegem, Belgium. Electronic address: Ivan.Huyghe@uza.be.
8
Department of Anesthesiology, Antwerp University Hospital, 2650 Edegem, Belgium. Electronic address: Stuart.Morrison@uza.be.
9
Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, 2650 Edegem, Belgium. Electronic address: Dirk.Ysebaert@uza.be.
10
Department of Gastroenterology and Hepatology, Antwerp University Hospital, 2650 Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Care Sciences, University of Antwerp, 2650 Edegem, Belgium. Electronic address: Sven.Franque@uza.be.

Abstract

INTRODUCTION:

Recently, there has been increasing interest in the preoperative prediction and prevention of post-hepatectomy liver failure (PHLF). This is a particular concern in colorectal liver metastases (CRLM), when surgery follows potentially hepatotoxic chemotherapy. Platelet-based liver scores (PBLS) such as APRI and FIB-4 are predictive of chemotherapy-associated liver injury (CALI) and PHLF. Estimation of the future liver remnant function (eFLRF) by combining 99mTc-Mebrofenin Hepatobiliary Scintigraphy (HBSBSA) with future liver remnant volume ratio (FLRV%), is predictive of PHLF and related mortality. We hypothesized that a HBSBSA based formula was a better predictor for PHLF than PBLS in chemotherapy-pretreated CRLM.

METHODS:

Between 2012 and 2016, 140 patients underwent liver resection for CRLM following systemic therapy. HBSBSA, FLRV%, eFLRF and PBLS were calculated and compared for their value in predicting PHLF.

RESULTS:

eFLRF and FLRV% had a better predictive value for PHLF than HBSBSA alone and APRI and FIB-4 (AUC = 0.800, 0.843 versus 0.652, 0.635 and 0.658 respectively). In a subgroup analysis (Oxaliplatin all, Oxaliplatin ≥ 6 cycles, Irinotecan all and Irinotecan ≥ 6 cycles), eFLRF was the only factor predictive for PHLF in all subgroups (all: p ≤ 0.05). Prediction of HBSBSA for chemotherapy associated steato-hepatitis (CASH) reached almost significance (p = 0.06). FIB-4 was predictive for sinusoidal obstruction syndrome (SOS) (p = 0.011). Only weak correlation was found between HBSBSA and PBLS.

CONCLUSION:

eFLRF is a better predictor of PHLF than PBLS or HBSBSA alone. PBLS seem to measure other aspects of liver function or damage than HBSBSA.

KEYWORDS:

Colorectal cancer; Hepatectomy; Liver failure; Liver function; Liver metastasis; Platelet count

PMID:
28988766
DOI:
10.1016/j.ejso.2017.08.009
[Indexed for MEDLINE]

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