Scintigraphic assessment of liver function in patients requiring liver surgery

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.