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Role of Preoperative Hepatobiliary Scintigraphy in Children Requiring Liver Resection
Kailash Chaurasiya1, Elena Kireeva, Mikhail Yadgarov
1From the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia.
Insights
Assessing future remnant liver function (FRLF) is crucial for preventing posthepatectomy liver failure (PHLF) in children. Hepatobiliary scintigraphy is beneficial for pediatric patients with future remnant liver volume (FRLV) below 25%.
Area of Science:
- Hepatobiliary scintigraphy
- Pediatric surgery
- Liver transplantation
Background:
- Posthepatectomy liver failure (PHLF) is a significant risk after major liver resection.
- Future remnant liver function (FRLF) assessment via hepatobiliary scintigraphy is established for adults, but not for pediatric patients.
- Established adult FRLF threshold is >2.7%/min per m² to prevent PHLF.
Purpose of the Study:
- To evaluate the utility of FRLF, future remnant liver volume (FRLV), and remnant liver volume to body weight ratio (RLV-BWR) in pediatric patients undergoing liver resection.
- To determine if existing adult FRLF thresholds are applicable to pediatric populations.
- To identify optimal parameters for assessing liver function and preventing PHLF in children.
Main Methods:
- Retrospective analysis of 77 pediatric patients with liver tumors undergoing 1-stage liver resection.
- Preoperative assessment of FRLF, FRLV, and RLV-BWR.
- Correlation of these parameters with the occurrence of PHLF.
Main Results:
- All patients had RLV-BWR >0.5%/kg.
- FRLV ranged from 19% to 89%, and FRLF ranged from 1.8% to 31.8%/min per m².
- Two patients developed PHLF (grade A and B); both had FRLV <25% but FRLF >2.7%/min per m².
Conclusions:
- FRLV and RLV-BWR are useful for preoperative liver assessment in most pediatric cases.
- FRLF assessment is particularly beneficial for pediatric patients with FRLV <25%.
- Further prospective studies are needed to establish a definitive FRLV cutoff for pediatric patients.
Purpose:
The risk of posthepatectomy liver failure (PHLF) remains an important concern following major liver resection. Assessment of future remnant liver function (FRLF) by hepatobiliary scintigraphy has shown its significance to prevent PHLF after major liver resection in adults with a threshold value of FRLF greater than 2.7%/min per m2. However, such data for pediatric patients were not published.
Methods:
A total of 77 pediatric patients with liver tumors who underwent 1-stage liver resection were included in this study. Assessment of FRLF, future remnant liver volume (FRLV), and the ratio of remnant liver volume to body weight (RLV-BWR) was performed before the surgery.
Results:
All patients had RLV-BWR values of more than 0.5%/kg. Future remnant liver volume values ranged from 19% to 89%, and FRLF values ranged from 1.8% to 31.8%/min per m2. Only 7 of 77 patients had FRLV values less than 25%, but their FRLF values exceeded 2.7%/min per m2. Two patients developed grade A and grade B PHLF.
Conclusion:
Future remnant liver volume and the RLV-BWR can be used in most pediatric patients for the assessment of liver before hepatectomy. According to our data, implementation of FRLF assessment using hepatobiliary scintigraphy can be most beneficial for children with FRLV of less than 25%. The cutoff value of FRLV greater than 25% can be slightly decreased with minimal risk of developing PHLF. However, to establish a new cutoff value for FRLV in children, further prospective studies including larger numbers of patients with FRLV of less than 25% are needed.
