The Impact of Modern Chemotherapy and Chemotherapy-Associated Liver Injuries (CALI) on Liver Function: Value of 99mTc-Labelled-Mebrofenin SPECT-Hepatobiliary Scintigraphy

Chemotherapy-Associated Liver Injuries: Unmet Needs and New Insights for Surgical Oncologists

“…In the presence of sinusoidal injury or NASH, the postoperative liver failure rate is more than 15% when the surgeons adopt a minimum value of FLR of 25%, and is between 10 and 15% when they rise the threshold to 30%. 7,16,[26][27][28][29] Even if these data did not correspond to an increased mortality rate (0% in most series), they suggest the need for an extension of the indications to preoperative portal vein occlusion. Robust evidence is still to provide.…”

“…3). 7,8,12,16,19 In patients without CALI, the postoperative liver failure rate was almost stable through series suggesting an adequate policy for patients' selection and an effective modulation of liver volume. This was not the case for patients with CALI that have a nonnegligible risk of liver failure, even after preoperative portal vein occlusion.…”

“…To date, only one paper explored this topic, and the results were not completely satisfactory. 16 HBS unveiled a reduced liver function of the future liver remnant (FLR) in patients with steatosis C30% and those with NAS (Nonalcoholic fatty liver disease Activity Score) [1, but not in those with sinusoidal dilatation. HBS measures hepatocellular function and could be able to predict only hepatocyte-related diseases, but its true potentialities have not been fully explored.…”

99mTc-mebrofenin hepatobiliary scintigraphy and volume metrics before liver preparation: correlations and discrepancies in non-cirrhotic patients

“…Cirrhosis can be diagnosed using morphological criteria on imaging; conversely, other factors, such as chemotherapy-induced lesions [sinusoidal obstruction syndrome (35), regenerative nodular hyperplasia (36), steatosis, or steatohepatitis (37)], are more difficult to detect despite advances in imaging (38). Chemotherapy-induced lesions increase the risk of post-operative complications (20,39). Liver biopsy is not routinely performed due to unequal distribution of parenchymal damage leading to sampling bias (40) and the risk of complications.…”

“…However, PHLF is not only related to FLR volume but also to many other factors among which several are linked to liver function, such as patient age (18), cholestasis, steatosis, fibrosis, and microvascular damage (19,20). PHLF still occurs in 1-39% of patients despite cautious preoperative volumetric evaluation (21,22).…”