Preoperative determination of the surgical procedure for hepatectomy using technetium‐99m‐galactosyl human serum albumin (99mTc‐GSA) liver scintigraphy

Technetium‐99m‐diethylenetriaminepentaacetic acidgalactosyl human serum albumin (Tc‐GSA) is a new liver scintigraphy agent which binds to the asialoglycoprotein receptors. We evaluated the preoperative assessment for hepatectomy using Tc‐GSA liver scintigraphy. Ninety patients with hepatocellular carcinoma were admitted for elective hepatectomy. Tc‐GSA scintigraphy was conducted after the intravenous injection of Tc‐GSA, and maximal removal rate of Tc‐GSA (GSA‐Rmax) was calculated using a radiopharmacokinetic model. Measurement of GSA‐Rmax, conventional liver function, and 15‐minute retention rate of indocyanine green (ICGR15) was carried out preoperatively. The relationships between liver functions, histological activity index (HAI), ICGR15, and GSA‐Rmax values were estimated. A significant correlation was obtained between GSA‐Rmax and ICGR15 (r = .534, P < .0001). Preoperative discrepancies between GSA‐Rmax and ICGR15 values were seen in 15 patients. In these cases, the GSA‐Rmax values correlated well with the total HAI scores (r = .595, P < .02), but no significant correlation was seen between the ICGR15 and HAI scores. Two patients died of postoperative liver failure within 2 months of the operation. These two patients were found to have severe discrepancies between their preoperative GSA‐Rmax and ICGR15 values. We concluded that GSA‐Rmax might be useful for selecting candidates for hepatectomy and that extended hepatectomies (di‐ and tri‐segmentectomy) are high‐risk surgical procedures in the case of low GSA‐Rmax scores (below 0.35).