In situliver transection with portal vein ligation for rapid growth of the future liver remnant in two-stage liver resection

2012 ◽  
Vol 100 (3) ◽  
pp. 388-394 ◽  
Author(s):  
W. T. Knoefel ◽  
I. Gabor ◽  
A. Rehders ◽  
A. Alexander ◽  
M. Krausch ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Rapid Growth ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Two Stage ◽  
Liver Remnant ◽  
The Future

scholarly journals Additional partial hepatectomy at the time of portal vein ligation accelerates the regeneration of the future liver remnant

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chuanfeng Hua ◽  
Weiwei Wei ◽  
Tianjiao Zhang ◽  
Fengming Xu ◽  
Olaf Dirsch ◽  
...  
Keyword(s):  
Portal Vein ◽  
Mrna Expression ◽  
Future Liver Remnant ◽  
Hepatocyte Proliferation ◽  
Nuclear Antigen ◽  
Proliferation Index ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
The Future ◽  
Additional Resection

AbstractPortal vein ligation (PVL) has been adopted to induce hypertrophy of the future liver remnant (FLR) in patients with primarily irresectable liver tumor. However, regeneration of the FLR is not always sufficient to allow curative resection of the portally-deprived tumor-bearing liver lobe. We hypothesize that simultaneous hepatectomy (PHx) and PVL augments regeneration of the FLR and that the effect is related to the extent of the additional resection. Seventy-two Lewis rats were enrolled into 3 groups: 20%PVL + 70%PHx; 70%PVL + 20%PHx; 90%PVL. Animals were observed for 1, 2, 3 and 7 days postoperatively (n = 6/time point). Liver enzymes, caudate liver/body-weight-ratio, BrdU-proliferation-index (PI), proliferating-cell-nuclear-antigen (PCNA)-mRNA-expression level and autophagy-related-proteins were evaluated. Compared with 90% PVL, additional PHx induced significantly more hypertrophy during the observation time, which was confirmed by significantly higher PI and higher level of PCNA-mRNA expression. Similarly, the additional PHx induced more autophagy in the FLR compared with PVL alone. However, both effects were not clearly related to the extent of additional resection. Additional resection augmented liver regeneration and autophagy substantially compared with PVL alone. Therefore, we concluded that autophagy might play a critical role in regulating hepatocyte proliferation and the size of the FLR after simultaneous PVL + PHx.

scholarly journals The Future Liver Remnant in Patients Undergoing the Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy Maintains the Immunological Components of a Healthy Organ

2016 ◽  
Vol 3 ◽  
Author(s):  
Ram Venkatesh Anantha ◽  
Christopher Ryan Shaler ◽  
Courtney Erin Meilleur ◽  
Jeremy Parfitt ◽  
S. M. Mansour Haeryfar ◽  
...  
Keyword(s):  
Portal Vein ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
The Future ◽  
Staged Hepatectomy

scholarly journals Rescue ALPPS: Intraoperative Conversion to ALPPS during Synchronous Resection of Rectal Cancer and Liver Metastasis

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Terence Jackson ◽  
Kelly A. Siegel ◽  
Christopher T. Siegel
Keyword(s):  
Liver Resection ◽  
Liver Metastasis ◽  
Portal Vein ◽  
Future Liver Remnant ◽  
Dropout Rate ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Patients At Risk ◽  
Synchronous Resection ◽  
Intraoperative Conversion

Future liver remnant (FLR) is the most important deciding factor in planning for liver resection. Portal vein embolization (PVE) was first introduced in the 1980s to induce liver hypertrophy, enabling removal of multiple/bilobar tumors. PVE was later combined with sequential hepatectomies with the aim of allowing the liver remnant to hypertrophy (15–20%) between procedures. However, the interval between the two procedures (3–8 weeks) put patients at risk for disease progression. With portal vein ligation alone or when combined with sequential hepatectomy, there is also a risk for inadequate liver hypertrophy because of intrahepatic portal collaterals leading to a high (19–30%) dropout rate. The ALPPS procedure (associating liver partition and portal vein ligation for staged hepatectomy) was recently developed as a feasible means to perform extensive/bilobar liver resections. It produces rapid, enormous hypertrophy of the remnant, making previously unresectable lesions resectable. Indications for ALPPS include any extensive liver resection with inadequate FLR. Here we present a novel indication for ALPPS as a rescue when inadequate FLR was faced intraoperatively, during a simultaneous resection of rectal primary and liver metastasis.

Portal vein embolization with n-butyl-cyanoacrylate before hepatectomy: a single-center retrospective analysis of 46 consecutive patients

2020 ◽  
pp. 028418512095380
Author(s):  
Marijela Moreno Berggren ◽  
Bengt Isaksson ◽  
Rickard Nyman ◽  
Charlotte Ebeling Barbier
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Local Anesthesia ◽  
Portal Vein Embolization ◽  
Liver Tumors ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Computed Tomography Images ◽  
The Future

Background Preoperative portal vein embolization (PVE) is performed to induce hypertrophy of the future liver remnant enabling major liver resection in patients with various types of liver tumors. Purpose To evaluate safety and effectiveness of PVE with n-butyl-cyanoacrylate (NBCA). Material and Methods All consecutive patients referred to our hospital for PVE between July 2006 and July 2017 were retrospectively reviewed. Volumetry was performed on computed tomography images before and after PVE, segmenting the total liver volume and the future liver remnant (FLR), i.e. liver segments I–III. Results PVE was performed in 46 patients (18 women, 28 men; mean age = 61 years) using local anesthesia. The ipsilateral technique was used in 45 patients. Adverse events were rare. The mean FLR volume increase was 56%, the degree of hypertrophy was 9.7%, and the kinetic growth rate was 2.1%/week. The median ± SD period between PVE and liver surgery was 7 ± 3 weeks. Forty-two patients (91%) had surgery; liver resection was performed in 37 (80%) patients. Three patients (7%) developed transient liver failure after surgery. There was no 90-day post-PVE or postoperative mortality. Conclusion PVE using NBCA through the ipsilateral approach in local anesthesia is safe and effective in inducing hypertrophy of the future liver remnant enabling surgery, and thereby increasing survival in patients with liver tumors.

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