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Author
K.P. Cieślak
Title
Scintigraphic assessment of liver function in patients requiring liver surgery
Supervisors
T.M. van Gulik
Co-supervisors
R.J. Bennink
Award date
18 January 2018
Number of pages
197
ISBN
978-94-6361-043-8
Document type
PhD thesis
Faculty
Faculty of Medicine (AMC-UvA)
Abstract
This thesis addresses various aspects of assessment of liver function using a quantitative liver function test, 99mTc-mebrofenin hepatobiliary scintigraphy (HBS). HBS enables direct measurement of at least one of the liver’s true processes with minimal external interference and offers the possibility of measurement of segmental liver function, i.e. direct measurement of future remnant liver (FRL) function. The research performed in this thesis offers a guideline in the preoperative management of patients who are candidates for extensive liver surgery, showing a significant reduction of postoperative liver failure and liver failure related complications in comparison to preoperative assessment with volumetric methods. Preoperative HBS enables a more function guided application of preoperative interventions to augment liver volume and function of the FRL such as portal vein embolization (PVE). Next to the monitoring of liver function after PVE, HBS can be used to predict the hypertrophy response 3 weeks after PVE. In this way, a futile PVE can be avoided in patients who are likely not to show sufficient hypertrophy after 3 weeks. These patients may benefit from alternative strategies such as classical two-stage resection or the ALPSS procedure. HBS can also be used for monitoring of the increase of liver function after the first stage of ALPPS or in patients who are treated with selective internal radiation therapy (SIRT). This thesis aims to contribute to the understanding of liver function tests and their use in risk assessment of patients requiring major liver resection.
Permalink
http://hdl.handle.net/11245.1/bba4016a-2be8-479c-8ef2-af755e6f28a3
Downloads
  • Thesis (complete) (Permanent embargo)

  • Front matter

  • Chapter 1: New perspectives in the assessment of future remnant liver (Permanent embargo)

  • Chapter 2: Comparison of techniques for volumetric analysis of the future liver remnant: implications for major hepatic resections (Embargo up to and including 18 January 2020)

  • Chapter 3: Measurement of liver function using hepatobiliary scintigraphy improves risk assessment in patients undergoing major liver resection

  • Chapter 4: Future remnant liver function as predictive factor for the hypertrophy response after portal vein embolization

  • Chapter 5: Liver related complications in unresectable disease after portal vein embolization

  • Chapter 6: 99mTc-mebrofenin hepatobiliary scintigraphy uptake and excretion phase in the preoperative management of patients with resectable perihilar cholangiocarcinoma (Embargo up to and including 18 January 2020)

  • Chapter 7: Liver function declines with increased age

  • Chapter 8: Assessment of liver function using Tc-99m-mebrofenin hepatobiliary scintigraphy in ALPPS (associating liver partition and portal vein ligation for staged hepatectomy)

  • Chapter 9: Monitoring of total and regional liver function after SIRT

  • Back matter

  • Stellingen

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