Regional Liver Function Assessment Using 99mTc-GSA SPECT/CT Scintigraphy in Malignant Perihilar Biliary Tumor Undergoing Major Liver Resection: A Dual-Center Cohort Study

Background Cholestasis can lead to unreliable results of routine liver function assessment tests in clinical practice and the functional cutoff value of hepatectomy is still unclear. The aim of this study was to determine which 99m Tc-GSA scintigraphy functional indicators can predict post-hepatectomy liver failure (PHLF) in patients before major liver resection due to malignant perihilar biliary disease. In addition, it aimed to assess the efficiency of functional future liver remnant (FLR) assessment of 99m Tc-GSA scintigraphy indicators. Patients and Methods A 99m Tc-GSA scintigraphy was performed prior to planned surgery in 187 patients, including 81 patients with major liver resection. The 99m Tc-GSA scintigraphy parameters including functional liver volume (FLV), ratio of the FLR functional volume to body weight (FLV FLR –BWR), and predictive residual index (PRI) were calculated from radioactive count in regions of FLR and total liver (TOTAL). Morphological liver volume (MLV) was calculated from computed tomography and standardized by standard liver volume (SLV). The efficacy of these parameters in predicting PHLF was compared using generalized linear mixed models and receiver operating characteristic (ROC) curve analysis. Results PHLF occurred in 22 patients, who showed lower MLV FLR /SLV, FLV FLR, FLV FLR /FLV TOTAL, FLV FLR –BWR, and PRI and higher resection rate ( P < 0.05 for all) than patients without PHLF. After adjusting for clinical parameters, a decreased FLV FLR –BWR (odds ratio, OR 0.17; 95% confidence intervals, CI 0.05–0.53) was found to be an independently significant indicator in the model of GLMM. FLV FLR –BWR (0.835) had the highest ROC among all liver functional indicators. Conclusions The FLR functional parameter preoperatively estimated from preoperative 99m Tc-GSA scintigraphy protocol is a promising tool for regional liver function assessment, and it can distinguish high-risk patients who may develop PHLF with malignant perihilar biliary tumor undergoing major liver resection.