Surgical outcomes of major hepatectomy following “radiation lobectomy” for hepatic malignancies and insufficiently functional future liver remnant: initial experience

Objectives. Portal vein embolization (PVE) stimulates hypertrophy of the future liver remnant (FLR) and improves the safety of extended hepatectomy. This study evaluated the efficacy of PVE, performed with PVA and coils, in relation to its effect on FLR volume and ratio. Secondary endpoints were the assessment of PVE complications, accomplishment of liver surgery, and patient outcome after hepatectomy. Materials and Methods. All patients who underwent PVE before planned major hepatectomy between 2013 and 2017 were retrospectively analyzed, comprising a total of 64 patients. Baseline patient clinical characteristics, imaging records, liver volumetric changes, complications, and outcomes were analyzed. Results. There were 45 men and 19 women with a mean age of 64 years. Colorectal liver metastasis was the most frequent liver tumor. The majority of patients (n = 53) had a right PVE. FLR increased from a mean value of 484 ml ± 242 to 654 ml ± 287 p<0.001 after PVE. Two major complications were experienced after PVE: 1 case of left hepatic artery branch laceration and 1 case of hemoperitoneum and hemothorax. A total of 44 (69%) patients underwent liver surgery. Twenty-one patients were not taken to surgery due to disease progression (n = 18), liver insufficiency (n = 1), and insufficient FLR volume (n = 1), and one patient declined surgery (n = 1). Conclusions. PVE with PVA and coils was accomplished safely and promoted a high FLR hypertrophy yield, enabling most of our patients to be submitted to the potentially curative treatment of liver tumor resection.

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The Future Liver Remnant

The American Surgeon ◽

10.1177/0003134820951451 ◽

2020 ◽

pp. 000313482095145 ◽

Cited By ~ 2

Author(s):

Matthew Dixon ◽

Jeffrey Cruz ◽

Nabeel Sarwani ◽

Niraj Gusani

Keyword(s):

Major Hepatectomy ◽

Growth Parameters ◽

Future Liver Remnant ◽

Liver Remnant ◽

Left Behind ◽

The Future

When considering patients for a major hepatectomy, one must carefully consider the volume of liver to be left behind and if additional procedures are necessary to augment its volume. This review considers the optimal volume of the future liver remnant (FLR) and analyzes the techniques of augmenting this volume, the various growth parameters to assess adequate growth of the FLR, as well as further management when there has been inadequate growth of the FLR.

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Assessment of Liver Remnant Using ICG Clearance Intraoperatively during Vascular Exclusion: Early Experience with the ALIIVE Technique

HPB Surgery ◽

10.1155/2015/757052 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Lawrence Lau ◽

Christopher Christophi ◽

Mehrdad Nikfarjam ◽

Graham Starkey ◽

Mark Goodwin ◽

...

Keyword(s):

Liver Failure ◽

Major Hepatectomy ◽

Significant Risk ◽

Future Liver Remnant ◽

Preoperative Assessment ◽

Parenchymal Transection ◽

Liver Remnant ◽

Posthepatectomy Liver Failure ◽

Vascular Exclusion ◽

Icg Clearance

Background. The most significant risk following major hepatectomy is postoperative liver insufficiency. Current preoperative assessment of the future liver remnant relies upon assumptions which may not be valid in the setting of advanced resection strategies. This paper reports the feasibility of the ALIIVE technique which assesses the liver remnant with ICG clearance intraoperatively during vascular exclusion. Methods. 10 patients undergoing planned major liver resection (hemihepatectomy or greater) were recruited. Routine preoperative assessment included CT and standardized volumetry. ICG clearance was measured noninvasively using a finger spectrophotometer at various time points including following parenchymal transection during inflow and outflow occlusion before vascular division, the ALIIVE step. Results. There were one case of mortality and three cases of posthepatectomy liver failure. The patient who died had the lowest ALIIVE ICG clearance (7.1%/min versus 14.4 ± 4.9). Routine preoperative CT and standardized volumetry did not predict outcome. Discussion/Conclusion. The novel ALIIVE technique is feasible and assesses actual future liver remnant function before the point of no return during major hepatectomy. This technique may be useful as a check step to offer a margin of safety to prevent posthepatectomy liver failure and death. Further confirmatory studies are required to determine a safety cutoff level.

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21. The Value of ICG Clearance Rate of the Future Liver Remnant in Predicting Postoperative Morbidity Following Major Hepatectomy for Biliary Cancer

Journal of Surgical Research ◽

10.1016/j.jss.2008.11.036 ◽

2009 ◽

Vol 151 (2) ◽

pp. 180-181

Author(s):

Y. Yokoyama ◽

H. Nishio ◽

T. Ebata ◽

T. Igami ◽

G. Sugawara ◽

...

Keyword(s):

Clearance Rate ◽

Postoperative Morbidity ◽

Major Hepatectomy ◽

Future Liver Remnant ◽

Biliary Cancer ◽

Liver Remnant ◽

The Future ◽

Icg Clearance

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Hepatocellular uptake index obtained with gadoxetate disodium-enhanced magnetic resonance imaging in the assessment future liver remnant function after major hepatectomy for biliary malignancy

BJS Open ◽

10.1093/bjsopen/zraa048 ◽

2021 ◽

Vol 5 (4) ◽

Author(s):

T Notake ◽

A Shimizu ◽

K Kubota ◽

T Ikehara ◽

H Hayashi ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Major Hepatectomy ◽

Multivariable Analysis ◽

Area Under The Curve ◽

Future Liver Remnant ◽

International Study ◽

Gadoxetate Disodium ◽

Liver Remnant ◽

Biliary Malignancy

Abstract Background Functional assessment of the future liver remnant (FLR) after major hepatectomy is essential but often difficult in patients with biliary malignancy, owing to obstructive jaundice and portal vein embolization. This study evaluated whether a novel index using gadoxetate disodium-enhanced MRI (EOB-MRI) could predict posthepatectomy liver failure (PHLF) after major hepatectomy for biliary malignancy. Methods The remnant hepatocellular uptake index (rHUI) was calculated in patients undergoing EOB-MRI before major hepatectomy for biliary malignancy. Receiver operating characteristic (ROC) curve analyses were used to evaluate the accuracy of rHUI for predicting PHLF grade B or C, according to International Study Group of Liver Surgery criteria. Multivariable logistic regression analyses comprised stepwise selection of parameters, including rHUI and other conventional indices. Results This study included 67 patients. The rHUI accurately predicted PHLF (area under the curve (AUC) 0.896). A cut-off value for rHUI of less than 0.410 predicted all patients who developed grade B or C PHLF. In multivariable analysis, only rHUI was an independent risk factor for grade B or C PHLF (odds ratio 2.0 × 103, 95 per cent c.i. 19.6 to 3.8 × 107; P < 0.001). In patients who underwent preoperative portal vein embolization, rHUI accurately predicted PHLF (AUC 0.885), whereas other conventional indices, such as the plasma disappearance rate of indocyanine green of the FLR and FLR volume, did not. Conclusion The rHUI is potentially a useful predictor of PHLF after major hepatectomy for biliary malignancy.

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