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Imagery tools predict morbidity rate in HCC after resection

Using CT and gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MRI to determine remnant functional liver volume can predict morbidity after hepatic resection due to hepatocellular carcinoma, according to a study published in Hepatology Research.

“Postoperative liver-related morbidity remains problematic,” Shinji Itoh, PhD, of the department of surgery and science, Kyushu University, and colleagues wrote. “This is the first clinical study that evaluates whether functional assessment of the future remnant liver using [gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced (EOB)] MRI and CT volumetry is a predictor of postoperative morbidity after hepatic resection in patients with HCC.”

One hundred forty-six patients — “carefully selected for major hepatic resection based on volumetric analysis of the remnant liver to prevent postoperative liver failure” according to researchers — were studied. Prior to surgery, patients’ mean characteristics were:

• median remnant liver function score was 1.82 (range, 1.25-2.96);
• median remnant liver volume was 90.1% (range, 43.9-99.3);
• volumetric rate was 571 mL/m² (range, 266-1,100);
• remnant functional liver using volumetric rate was 155.9 mL/m² (range, 64.7-285.3); and
• volume was 1,027 (range, 369-2,148).

Researchers used indocyanine green retention rate and severity of a patient’s liver damage to determine how much of the organ was removed.

Post-surgery, researchers reported limited hepatic resection in 65 patients, subsegmentectomy of the liver in 26 patients, segmentectomy in 32 patients and two or more segmentectomies in 23 patients. Nineteen patients suffered morbidity classified as grade 3 or greater — liver failure, hepatic encephalopathy, pleural effusion that necessitated invasive treatment or refractory ascites. Liver-related death occurred in seven patients. No patients died during surgery, within 30 days of it, or during the same hospital admission, according to researchers.

“Remnant functional liver volume using CT volumetry and EOB-MRI is a useful predictor for liver-related morbidity after hepatic resection in patients with HCC,” Itoh and colleagues wrote. “Assessments of remnant functional liver volume would help hepatic surgeons more accurately estimate the remnant liver functional reserve after hepatic resection.” – by Janel Miller

Disclosures: The researchers report no relevant financial disclosures.