Preoperative estimation of risk in hepatectomy using technetium-99m-galactosyl human serum albumin receptor amount by nonlinear 3-compartment model

Background/Aims: Recently, we developed the method for measurement of the technetium-99m-diethylenetriamine-pentaacetic acid-galactosyl human serum albumin (Tc-GSA) receptor amount (R0) using a nonlinear 3-compartment model. We examined the usefulness of R0 for preoperative estimation of risk in hepatectomy. Methodology: Sixty-three patients who underwent hepatectomy in our hospital were examined for R0. These patients consisted of 26 cases of normal liver, 16 cases of liver fibrosis, and 21 cases of cirrhosis. R0 was measured by the nonlinear 3-compartment model of ligand-receptor binding without blood sampling in Tc-GSA scintigraphy. The expected remnant liver R0 after hepatectomy was calculated from CT volumetry before hepatectomy. Results: The preoperative mean R0 of liver was 15.8±3.8mg for Z0, 13.8±3.9mg for Z1, and 6.9±2.3mg for Z2. R0 in Z2 was significantly lower than Z0 and Z1 (p<0.0001). Every patient whose remnant liver R0 was over 5mg tolerated hepatectomy without any postoperative complications. Among 63 cases, 5 patients developed postoperative complications (two liver failures, two postoperative jaundice and one hepatic coma), and remnant liver R0 of these patients were under 5mg. Conclusions: From these results, it can be seen that R0 of remnant liver is a useful parameter to decide indication of hepatectomy and predict postoperative complications.