Preoperative assessment of liver function

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Diagnostic imaging

Background:

• Hepatic resection decisions rely heavily on surgical judgment and the Child-Pugh (CP) score.
• Existing tools like indocyanine green (ICG) retention testing have questionable accuracy and reproducibility.
• There's a need for improved methods to assess liver function and identify high-risk patients for resection.

Purpose of the Study:

• To evaluate the utility of 99m-Tc GSA scintigraphy as an adjunct to the CP score for assessing liver function.
• To determine if GSA scintigraphy can better identify poor-risk Child-Pugh Class A patients undergoing hepatic resection.
• To explore the potential of GSA scintigraphy in documenting compensatory hyperplasia after portal vein embolization.

Main Methods:

• Review of current assessment tools for hepatic resection, including CP score, ICG retention, and radiographic testing.
• Discussion of the limitations and scientific validity of existing methods.
• Introduction of 99m-Tc GSA scintigraphy as a potential advanced diagnostic tool.

Main Results:

• The CP score remains the primary tool, but its limitations necessitate supplementary assessments.
• ICG retention testing's accuracy and reproducibility are debated, suggesting it may not significantly improve risk stratification beyond the CP score.
• 99m-Tc GSA scintigraphy offers volumetric and kinetic data, potentially providing a more nuanced view of liver function.

Conclusions:

• 99m-Tc GSA scintigraphy shows promise for assessing liver function and compensatory hyperplasia, particularly after portal vein embolization.
• Further large-scale studies correlating GSA scan results with clinical outcomes are required to validate its predictive value.
• The goal is to find a test that augments, rather than mimics, the CP score to refine patient selection for hepatic resection.