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(99 m) Tc-mebrofenin hepatobiliary scintigraphy with SPECT for the assessment of hepatic function and liver functional volume in a rat model of ALPPS
e292
Electronic Poster Abstracts
Results: Patient characteristics were similar, except for age, weight and American Society of Anesthesiologists (ASA) score that were lower in LD. Post-operative factor V and bilirubin levels were, respectively, higher and lower in patients with PVE compared with patients without PVE or LD (P < 0.05). Patients with PVE had an increased blood loss, blood transfusions and sinusoidal obstruction syndrome. The day-3 bilirubin level was 40% lower in the PVE group compared with the no-PVE group after adjustment for body weight, chemotherapy, operating time, Pringle time, blood transfusions, remnant liver volume, pre-operative bilirubin level and pre-operative prothrombin ratio (P = 0.001). Conclusions: For equivalent volumes, the immediate postoperative hepatic function appears to be better in livers prepared with PVE than in unprepared livers. Future studies should analyse whether the conventional inferior volume limit that allows a safe liver resection may be lowered when a PVE is performed.
EP01E-015 DIAGNOSIS OF HEPATOCELLULAR CANCER POST KATRINA NEW ORLEANS J. Buell1, P. Friedlander1, E. Kandil1, E. Kane2 and L. Balart3 1 Surgery, 2Tulane University, and 3Medicine, Tulane University, United States Introduction: Natural disasters frequently disrupt routine healthcare but little data exists on their effect on cancer surveillance on tumors such as Hepatocellular Cancer. Methods: Utilizing the SEER database we evaluated 8315 cases from three registries New Orleans, Atlanta, Detroit, and San Francisco. Survival analyses compared Pre and Post Katrina periods. Results: 3998 cases occurred Pre-Katrina and 4317 PostKatrina. The majority of patients were 55 to 69 years of age with the minority female (30.3%) and African American (22.6%). AA (n = 2030) in both eras and all SEERs presented at earlier ages (58.4 vs. 62.9, p < 0.0001) and advanced disease compared to Caucasians (p = 0.014). No increase in AA incidence (28.7% vs. 26.1%, p = NS) was identified between era. However earlier stage at diagnosis was identified post-Katrina (p < 0.0001). Post-Katrina New Orleans experienced no increased incidence of HCC (n = 419 vs. 352) but had a 7% increase incidence of localized disease and a 13% reduction in regional and distant disease. One- and three-year survival improved from Pre to Post Katrina (32.3% to 51.1%) and (17.6% to 43.8%) across all SEERs and races (p < 0.0001) with Caucasians having a 1.34-fold improved survival (p < 0.0001). Post-Katrina New Orleans saw 15% and 34% increases in 1- and 3- yr survival. Conclusions: HCC diagnosis improved over the last decade in both races with ASSLD tumor screening. In all SEERs AA’s develop HCC at a younger age and suffer disparate survival compared to Caucasians. This racial disparity was not limited to New Orleans and remained constant pre- to post-Katrina groups.
EP01E-017 (99 M) TC-MEBROFENIN HEPATOBILIARY SCINTIGRAPHY WITH SPECT FOR THE ASSESSMENT OF HEPATIC FUNCTION AND LIVER FUNCTIONAL VOLUME IN A RAT MODEL OF ALPPS R. García Perez1, J. Ferrer2, I. Bachero2, J. Pavia3, M. Perlaza3, F. Lomeña3, J. Fuster1 and J. C. García-Valdecasas2 1 HPB and Transplant Surgery, 2Hospital Clinic, and 3 Nuclear Medicine, Spain Introduction: Evaluation of liver function in ALPPS remains a challenge. Hepatobiliary scintigraphy (HBS) enables the assessment of total and regional liver function. We have analysed the use of a dynamic pinhole scintigraphy in a rat model of ALPPS. Methods: HBS was performed in 9 rats with 99mTcmebrofenin on a dedicated animal pinhole gamma camera. The hepatic uptake rate and volume was calculated using a specialised program. The degree of hepatocellular injury and synthetic function were assessed by liver blood tests and histopathology. HBS was performed before the surgery, at 48 hours and 8 days after the surgical procedure. Results: HBS in rats was feasible. There is an increase from the 26% volume to nearly 40% after 48 hours and greater than 50% at 8 days. These results run parallel but not proportional when it comes to the function evaluation though. The liver takes 8 days for the function to achieve an increase up to 40%. Conclusion: HBS offers a unique combination of functional and volume liver assessment with the ability to determine the liver function reserve before and after an intervention in rats which undergo ALPPS procedure.
EP01E-018 THE ROLE OF THE TRANSCRIPTION FACTOR NRF2 AS A POTENTIAL ENHANCER OF HEPATIC REGENERATION M. Elmasry1,2, N. Bird1,2, F. Zhang1, C. Goldring1, N. Kitteringham1, H. Malik2, G. Poston2 and S. Fenwick2 1 Molecular and Clinical Pharmacology, University of Liverpool, and 2HPB Surgery, Aintree University Hospital NHS Foundation Trust, United Kingdom Introduction: The liver has a remarkable capacity for regeneration following hepatectomy; however, acute hepatic failure remains a significant and often fatal complication following major hepatectomy. The transcription factor Nrf2 plays a pivotal role as a master regulator of cyto-protection against oxidative stress, nevertheless, its role in hepatic regeneration is still ill-defined. We sought to investigate the prospect of Nrf2 as a potential enhancer of hepatic regeneration, which could pave the way for promising translational outcomes. Methods: A mouse model was used utilising C57BL/6 J mice and 2/3 partial hepatectomy was performed, followed by culling the mice at different time points.
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
Results: Patient characteristics were similar, except for age, weight and American Society of Anesthesiologists (ASA) score that were lower in LD. Post-operative factor V and bilirubin levels were, respectively, higher and lower in patients with PVE compared with patients without PVE or LD (P < 0.05). Patients with PVE had an increased blood loss, blood transfusions and sinusoidal obstruction syndrome. The day-3 bilirubin level was 40% lower in the PVE group compared with the no-PVE group after adjustment for body weight, chemotherapy, operating time, Pringle time, blood transfusions, remnant liver volume, pre-operative bilirubin level and pre-operative prothrombin ratio (P = 0.001). Conclusions: For equivalent volumes, the immediate postoperative hepatic function appears to be better in livers prepared with PVE than in unprepared livers. Future studies should analyse whether the conventional inferior volume limit that allows a safe liver resection may be lowered when a PVE is performed.
EP01E-015 DIAGNOSIS OF HEPATOCELLULAR CANCER POST KATRINA NEW ORLEANS J. Buell1, P. Friedlander1, E. Kandil1, E. Kane2 and L. Balart3 1 Surgery, 2Tulane University, and 3Medicine, Tulane University, United States Introduction: Natural disasters frequently disrupt routine healthcare but little data exists on their effect on cancer surveillance on tumors such as Hepatocellular Cancer. Methods: Utilizing the SEER database we evaluated 8315 cases from three registries New Orleans, Atlanta, Detroit, and San Francisco. Survival analyses compared Pre and Post Katrina periods. Results: 3998 cases occurred Pre-Katrina and 4317 PostKatrina. The majority of patients were 55 to 69 years of age with the minority female (30.3%) and African American (22.6%). AA (n = 2030) in both eras and all SEERs presented at earlier ages (58.4 vs. 62.9, p < 0.0001) and advanced disease compared to Caucasians (p = 0.014). No increase in AA incidence (28.7% vs. 26.1%, p = NS) was identified between era. However earlier stage at diagnosis was identified post-Katrina (p < 0.0001). Post-Katrina New Orleans experienced no increased incidence of HCC (n = 419 vs. 352) but had a 7% increase incidence of localized disease and a 13% reduction in regional and distant disease. One- and three-year survival improved from Pre to Post Katrina (32.3% to 51.1%) and (17.6% to 43.8%) across all SEERs and races (p < 0.0001) with Caucasians having a 1.34-fold improved survival (p < 0.0001). Post-Katrina New Orleans saw 15% and 34% increases in 1- and 3- yr survival. Conclusions: HCC diagnosis improved over the last decade in both races with ASSLD tumor screening. In all SEERs AA’s develop HCC at a younger age and suffer disparate survival compared to Caucasians. This racial disparity was not limited to New Orleans and remained constant pre- to post-Katrina groups.
EP01E-017 (99 M) TC-MEBROFENIN HEPATOBILIARY SCINTIGRAPHY WITH SPECT FOR THE ASSESSMENT OF HEPATIC FUNCTION AND LIVER FUNCTIONAL VOLUME IN A RAT MODEL OF ALPPS R. García Perez1, J. Ferrer2, I. Bachero2, J. Pavia3, M. Perlaza3, F. Lomeña3, J. Fuster1 and J. C. García-Valdecasas2 1 HPB and Transplant Surgery, 2Hospital Clinic, and 3 Nuclear Medicine, Spain Introduction: Evaluation of liver function in ALPPS remains a challenge. Hepatobiliary scintigraphy (HBS) enables the assessment of total and regional liver function. We have analysed the use of a dynamic pinhole scintigraphy in a rat model of ALPPS. Methods: HBS was performed in 9 rats with 99mTcmebrofenin on a dedicated animal pinhole gamma camera. The hepatic uptake rate and volume was calculated using a specialised program. The degree of hepatocellular injury and synthetic function were assessed by liver blood tests and histopathology. HBS was performed before the surgery, at 48 hours and 8 days after the surgical procedure. Results: HBS in rats was feasible. There is an increase from the 26% volume to nearly 40% after 48 hours and greater than 50% at 8 days. These results run parallel but not proportional when it comes to the function evaluation though. The liver takes 8 days for the function to achieve an increase up to 40%. Conclusion: HBS offers a unique combination of functional and volume liver assessment with the ability to determine the liver function reserve before and after an intervention in rats which undergo ALPPS procedure.
EP01E-018 THE ROLE OF THE TRANSCRIPTION FACTOR NRF2 AS A POTENTIAL ENHANCER OF HEPATIC REGENERATION M. Elmasry1,2, N. Bird1,2, F. Zhang1, C. Goldring1, N. Kitteringham1, H. Malik2, G. Poston2 and S. Fenwick2 1 Molecular and Clinical Pharmacology, University of Liverpool, and 2HPB Surgery, Aintree University Hospital NHS Foundation Trust, United Kingdom Introduction: The liver has a remarkable capacity for regeneration following hepatectomy; however, acute hepatic failure remains a significant and often fatal complication following major hepatectomy. The transcription factor Nrf2 plays a pivotal role as a master regulator of cyto-protection against oxidative stress, nevertheless, its role in hepatic regeneration is still ill-defined. We sought to investigate the prospect of Nrf2 as a potential enhancer of hepatic regeneration, which could pave the way for promising translational outcomes. Methods: A mouse model was used utilising C57BL/6 J mice and 2/3 partial hepatectomy was performed, followed by culling the mice at different time points.
HPB 2016, 18 (S1), e1ee384