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Background The relationship between posthepatectomy complications and liver functional parameters was preliminary reported in a pilot study. The present study sequentially evaluated the clinical significance of maximal removal rate of technetium-99m-galactosyl human serum albumin (GSAR max ) in the future remnant liver (rGSAR max ) in patients to predict posthepatectomy complications.Methods Between 2010 and August 2017, GSAR max , rGSAR max , their difference (Dif), and the rGSAR max to GSAR max ratio were examined in 247 additional patients who underwent hepatectomy for liver and biliary diseases. Hepatectomy-related postoperative complications (i.e. longterm ascites, intra-abdominal infection, and hepatic failure) occurred in 73 (29.6%) patients. ResultsThe median and mean preoperative GSAR max values were 0.477 and 0.498 ± 0.166 mg/min, respectively; rGSAR max values were 0.341 and 0.366 ± 0.145 mg/min, respectively; Dif values were 0.105 and 0.132 ± 0.111 mg/ min, respectively; and the rGSAR max to GSAR max ratio values were 0.774 and 0.746 ± 0.177, respectively. Among these, the GSAR max and rGSAR max values were significantly correlated with the liver functional parameters ICGR15, LHL15, HH15, prothrombin activity, serum hyaluronic acid level, and platelet count (all P < 0.01). The rGSAR max values were significantly lower in patients with long-term ascites (P < 0.05), and the predictive cutoff values of rGSAR max were 0.290 mg/min; however, the multivariate logistic regression analysis showed that rGSAR max was not independently related to long-term ascites. ConclusionWhen accompanied by other functional liver reserve parameters, rGSAR max seemed to be an alternative liver functional parameter related to ascites. Nucl Med Commun 40:145-152