Comparison of Clinical Outcomes following Glue versus Polyvinyl Alcohol Portal Vein Embolization for Hypertrophy of the Future Liver Remnant prior to Right Hepatectomy

Colorectal liver metastases (CRLM) are the major cause of death in patients with colorectal cancer (CRC). The cornerstone treatment of CRLM is surgical resection. Post-operative morbidity and mortality are mainly linked to an inadequate future liver remnant (FLR). Nowadays preoperative portal vein embolization (PVE) is the most widely performed technique to increase the size of the future liver remnant (FLR) before major hepatectomies. One method recently proposed to increase the FLR is liver venous deprivation (LVD), but its oncological impact is still unknown. The aim of this study is to report first short- and long-term oncological outcomes after LVD in patients undergoing right (or extended right) hepatectomy for CRLM. Seventeen consecutive patients undergoing LVD between July 2015 and May 2020 before an (extended) right hepatectomy were retrospectively analyzed from an institutional database. Post-operative and follow-up data were analyzed and reported. Primary outcomes were 1-year and 3-year overall survival (OS) and hepatic recurrence (HR). Postoperative complications occurred in 8 patients (47%). No deaths occurred after surgery. HR occurred in 9 patients (52.9%). 1-year and 3-year OS were 87% (95% confidence interval [CI]: ±16%) and 60.3%, respectively (95% CI: ±23%). Median Disease-Free Survival (DFS) was 6 months (CI 95%: 4.7–7.2). With all the limitations of a retrospective study with a small sample size, LVD showed similar oncological outcomes compared to literature reports for Portal Vein Embolization (PVE).

Download Full-text

Preoperative Portal Vein Embolization with N-Butyl Cyanoacrylate Plus Ethiodized Oil: More Rapid and Robust Hypertrophy of the Future Liver Remnant!

Radiology ◽

10.1148/radiol.2021210368 ◽

2021 ◽

pp. 210368

Author(s):

Ronald S. Arellano

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Liver Remnant ◽

The Future ◽

Ethiodized Oil

Download Full-text

Successful Thrombectomy via a Surgically Reopened Umbilical Vein for Extended Portal Vein Thrombosis Caused by Portal Vein Embolization prior to Extended Liver Resection

Case Reports in Gastroenterology ◽

10.1159/000508743 ◽

2020 ◽

Vol 14 (2) ◽

pp. 320-328

Author(s):

Wouter J.M. Derksen ◽

Iris E.M. de Jong ◽

Carlijn I. Buis ◽

Koen M.E.M. Reyntjens ◽

G. Matthijs Kater ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Thrombosis ◽

Portal Vein Embolization ◽

Liver Surgery ◽

Umbilical Vein ◽

Future Liver Remnant ◽

Main Stem ◽

Liver Remnant ◽

Vein Thrombosis ◽

The Future

Selective portal vein embolization (PVE) before extended liver surgery is an accepted method to stimulate growth of the future liver remnant. Portal vein thrombosis (PVT) of the main stem and the non-targeted branches to the future liver remnant is a rare but major complication of PVE, requiring immediate revascularization. Without revascularization, curative liver surgery is not possible, resulting in a potentially life-threatening situation. We here present a new surgical technique to revascularize the portal vein after PVT by combining a surgical thrombectomy with catheter-based thrombolysis via the surgically reopened umbilical vein. This technique was successfully applied in a patient who developed thrombosis of the portal vein main stem, as well as the left portal vein and its branches to the left lateral segments after selective right-sided PVE in preparation for an extended right hemihepatectomy. The advantage of this technique is the avoidance of an exploration of hepatoduodenal ligament and a venotomy of the portal vein. The minimal surgical trauma facilitates additional intravascular thrombolytic therapy as well as the future right extended hemihepatectomy. We recommend this technique in patients with extensive PVT in which percutaneous less invasive therapies have been proven unsuccessful.

Download Full-text

Trans-Splenic Portal Vein Embolization: A Technique to Avoid Damage to the Future Liver Remnant

CardioVascular and Interventional Radiology ◽

10.1007/s00270-016-1359-5 ◽

2016 ◽

Vol 39 (10) ◽

pp. 1514-1518 ◽

Cited By ~ 3

Author(s):

Ammar Sarwar ◽

Olga R. Brook ◽

Jeffrey L. Weinstein ◽

Khalid Khwaja ◽

Muneeb Ahmed

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Liver Remnant ◽

The Future

Download Full-text

Preoperative portal vein embolization followed by right hepatectomy to treat a complex common bile duct injury in a 5-year-old child

World Journal of Pediatric Surgery ◽

10.1136/wjps-2018-000033 ◽

2019 ◽

Vol 2 (2) ◽

pp. e000033

Author(s):

Juan Glinka ◽

Rocio Bruballa ◽

Martin de Santibañes ◽

Rodrigo Sanchez Clariá ◽

Victoria Ardiles ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Portal Vein ◽

Portal Vein Embolization ◽

Pediatric Population ◽

Future Liver Remnant ◽

Liver Parenchyma ◽

Definitive Treatment ◽

Right Hepatectomy ◽

Liver Remnant

BackgroundCommon bile duct injuries (CBDIs) remains a rare but serious complication in children undergoing laparoscopic cholecystectomy (LC), with an incidence of 0.44%. In severe lesions, a major liver resection may be necessary as a definitive treatment. The current principles for safe hepatectomy are mainly focused on the liver parenchyma that remains after resection. Therefore, one of the main factors related to posthepatectomy hepatic insufficiency is the quantity and quality of the future liver remnant (FLR). To achieve an optimal FLR, techniques such as portal vein embolization (PVE) are available.Case presentationWe present the case of a 5-year-old child with a severe CBDI after LC, treated with preoperative PVE followed by a right hepatectomy as definitive treatment. No reports of liver resections and PVE are described in the literature concerning the pediatric population.

Download Full-text

Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review

CardioVascular and Interventional Radiology ◽

10.1007/s00270-021-02877-3 ◽

2021 ◽

Author(s):

E. A. Soykan ◽

B. M. Aarts ◽

M. Lopez-Yurda ◽

K. F. D. Kuhlmann ◽

J. I. Erdmann ◽

...

Keyword(s):

Systematic Review ◽

Portal Vein ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Liver Remnant ◽

The Future ◽

Quantitative Synthesis ◽

Neo Adjuvant Chemotherapy ◽

Meta Analyses ◽

Subsequent Literature

AbstractThis systematic review was conducted to determine factors that are associated with the degree of hypertrophy of the future liver remnant following portal vein embolization. An extensive search on September 15, 2020, and subsequent literature screening resulted in the inclusion of forty-eight articles with 3368 patients in qualitative analysis, of which 18 studies were included in quantitative synthesis. Meta-analyses based on a limited number of studies showed an increase in hypertrophy response when additional embolization of segment 4 was performed (pooled difference of medians = − 3.47, 95% CI − 5.51 to − 1.43) and the use of N-butyl cyanoacrylate for portal vein embolization induced more hypertrophy than polyvinyl alcohol (pooled standardized mean difference (SMD) = 0.60, 95% CI 0.30 to 0.91). There was no indication of a difference in degree of hypertrophy between patients who received neo-adjuvant chemotherapy and those who did not receive pre-procedural systemic therapy(pooled SMD = − 0.37, 95% CI − 1.35 to 0.61), or between male and female patients (pooled SMD = 0.19, 95% CI − 0.12 to 0.50).The study was registered in the International Prospective Register of Systematic Reviews on April 28, 2020 (CRD42020175708).

Download Full-text

A Comparison of Portal Vein Embolization With Poly(2-hydroxyethylmethacrylate) and a Histoacryl/Lipiodol Mixture in Patients Scheduled for Extended Right Hepatectomy

Physiological Research ◽

10.33549/physiolres.932992 ◽

2015 ◽

pp. 841-848 ◽

Cited By ~ 1

Author(s):

J. H. PEREGRIN ◽

R. JANOUŠEK ◽

D. KAUTZNEROVÁ ◽

M. OLIVERIUS ◽

E. STICOVÁ ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Right Hepatectomy ◽

Portal Vein Branch ◽

Liver Remnant ◽

Extended Right Hepatectomy ◽

The Right ◽

Transhepatic Access ◽

Flr Hypertrophy

ght hepatectomy and whether it is as effective as the currently used agent (a histoacryl/lipiodol mixture). Two groups of nine patients each scheduled for extended right hepatectomy for primary or secondary hepatic tumor, had right portal vein embolization in an effort to induce future liver remnant (FLR) hypertrophy. One group had embolization with PHEMA, the other one with the histoacryl/lipiodol mixture. In all patients, embolization was performed using the right retrograde transhepatic access. Embolization was technically successful in all 18 patients, with no complication related to the embolization agent. Eight patients of either group developed FLR hypertrophy allowing extended right hepatectomy. Likewise, one patient in each group had recanalization of a portal vein branch. Histology showed that both embolization agents reach the periphery of portal vein branches, with PHEMA penetrating somewhat deeper into the periphery. PHEMA has been shown to be an agent suitable for embolization in the portal venous system comparable with existing embolization agent (histoacryl/lipiodol mixture).

Download Full-text