99mTc-Galactosyl Syalil Albumin (GSA) Scintigram Adjusts Hepatic Resection Range in ICG Based Estimation

Background/Aims: Indocyanin Green (ICG)-based diagnosis is widely accepted in determination of hepatic resection range, however, we frequently encounter scattered results of preoperative assessment. The aim of this study was to clarify the role of Tc-99m Galactosyl sialyl albumin (GSA) scintigram in the decision of the resection range. Methodology: One hundred and eighty patients who underwent liver resection were included in this study The patients were divided according to ICGR15 value as follows; Group 1 (n=100): ICG R15 <15%, Group 2 (n=32): ICGR15 15-20%, Group 3 (n=32): ICGR15 20-25% and Group 4 (n=8):ICGR15 >25%. Each group was divided into two subgroups by their GSA-LHL 0.9 levels and compared with regards to liver function, portal pressure and HAI score of background liver. The frequency of complications was also compared to previous cases without GSA-LHL estimation (n=64). Results: In Groups 2 and 3, the GSA-LHL >= 0.9 subgroup showed better platelet counts, portal pressure and lower HAI score. In groups of GSA-LHL >= 0.9, platelet counts showed higher value between below 20% of ICGR15 and above that, while GSA-LHL<0.9 showed no difference in groups exceeding 15% of ICGR15. Overall complications occurred less in GSA-LHL >= 0.9 compared to previous cases without GSA-LHL estimation. Conclusions: Levels of GSA-LHL reflects severity of portal hypertension in moderately damaged liver preoperatively and could contribute to the decision of the range of resection with low morbidity.