Document Detail

Liver scintigraphy is useful for selecting candidates for preoperative transarterial chemoembolization among patients with hepatocellular carcinoma and chronic liver disease.
MedLine Citation:
PMID:  10612533     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The indications for preoperative hepatic transarterial chemoembolization (TACE) have not been clarified by recent studies in patients with hepatocellular carcinoma (HCC) complicated by chronic liver diseases. The aim of the present study was to investigate which patients benefit most from preoperative TACE on the basis of hepatic functional reserve. Technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin (Tc-GSA) liver scintigraphy was used to assess hepatic functional reserve before and after TACE. PATIENTS AND METHODS: Liver scintigraphy was performed before and several weeks after TACE in 64 patients with HCC complicated by chronic hepatitis or cirrhosis. The ratio of liver to heart-plus-liver radioactivity of Tc-GSA 15 minutes after injection (LHL15) was calculated. Conventional hepatic functional tests were also performed. Whether to perform hepatectomy after TACE was decided mainly on the basis of the previously reported value of LHL15 > or =0.91. RESULTS: LHL15, prothrombin time, and serum concentration of cholinesterase significantly decreased after TACE in patients with LHL15 > or =20.91 (P <0.01, P <0.05, and P <0.05, respectively). In patients with LHL15 <0.91, LHL15 and functional liver volume significantly increased after TACE (both P <0.05). Eight patients with LHL15 > or =0.91 did not undergo hepatectomy because LHL15 decreased to less than 0.91 after TACE, whereas 7 patients with LHL15 <0.91 underwent hepatectomy because LHL15 increased to more than 0.91 after TACE. Three major postoperative complications occurred in patients with LHL15 > or =0.91, and no major complications occurred in patients with LHL15 <0.91. CONCLUSIONS: The results suggest that preoperative TACE should be performed in HCC patients only when LHL15 is less than 0.91, and that preoperative TACE is not an appropriate treatment for patients with LHL15 > or =0.91 when HCC is resectable.
H Nakano; K Yoshida; S Takeuchi; K Kumada; M Yamaguchi; D Jaeck
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of surgery     Volume:  178     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  1999 Nov 
Date Detail:
Created Date:  2000-01-05     Completed Date:  2000-01-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  385-9     Citation Subset:  AIM; IM    
Department of Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
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MeSH Terms
Aged, 80 and over
Carcinoma, Hepatocellular / complications,  radionuclide imaging*,  surgery
Chemoembolization, Therapeutic*
Decision Making
Heart / radionuclide imaging
Hepatitis, Chronic / pathology,  radionuclide imaging*,  surgery
Liver / radionuclide imaging*
Liver Cirrhosis / pathology,  radionuclide imaging*,  surgery
Liver Neoplasms / complications,  radionuclide imaging*,  surgery
Middle Aged
Patient Selection
Predictive Value of Tests
Preoperative Care
Radiopharmaceuticals / diagnostic use
Technetium Tc 99m Aggregated Albumin / diagnostic use
Technetium Tc 99m Pentetate / diagnostic use
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Technetium Tc 99m Aggregated Albumin; 0/technetium Tc 99m DTPA-galactosyl-human serum albumin; 65454-61-7/Technetium Tc 99m Pentetate

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