C. Baillet

Drop of Total Liver Function in the Interstages of the New Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Technique: Analysis of the "Auxiliary Liver" by HIDA Scintigraphy.

To induce rapid hepatic hypertrophy and to reduce posthepatectomy liver failure (PHLF), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients with a limited future remnant liver (FRL). Nevertheless, high morbidity rates and mortality up to 12 % were reported. As a potential explanation of the poor outcome of ALPPS, little is known about the improvement in FRL function in the interstages period that was shown to be determinant for ALPPS outcome. Here, we report a new technique of evaluation of the liver function in the setting of ALPPS using sequential hepatobiliary scintigraphy (HBS) using Technetium-99m labeled Hepatobiliary IminoDiacetic Acid (HIDA) compounds ((99m)Tc-mebrofenin) with single photon emission computed tomography. Five patients (53–80 years of age) scheduled for extended hepatectomy underwent ALPPS for colorectal liver metastases (N 1⁄4 4) in 4 cases and gallbladder carcinoma (N 1⁄4 1) after giving informed consent. The colorectal liver metastases’ patients had received extensive chemotherapy (6–25 cures). The first stage of ALPPS was preceded by portal vein embolization in 3 patients with an anticipated FRL to body weight ratio 0.5%, including 2 salvage ALPPS due to almost-nil hypertrophy after portal vein embolization. All patients had sequential determinations of FRL and total liver volumes by computed tomography volumetric measurement combined with functional assessment by HBS as previously described, in the immediate preoperative period of stage 1 and between the 2 stages after a delay of 5 to 7 days following the first stage in 4 patients and 11 days in the elderly patient who badly tolerated the liver partition. HBS results were reported as the mebrofenin uptake of the total liver and FRL (TLU and RLU; %/min m). The increase in FRL function was compared with the volume increase, with increase rates expressed as relative increases (ie, postoperative FRL— preoperative FRL/preoperative FRL). Preoperatively, the median FRL to body weight ratio was 0.43% (0.3%–0.5%). Hepatic biological parameters remained near