Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the prospective remnant liver volume 705

Abstract Background: Portal vein embolization (PVE) is a common procedure to induce hypertrophy of the remnant liver (RL) before major hepatectomy. Objective: Evaluate increased RL volume after PVE based on CT volumetric measurement. Methods: Multi-detector computed tomography (MDCT) was used to measure hepatic volumetric measurement, including total liver volume and RL volumes of pre- and post-PVE. Complications were recorded from PVE and from three-month after post-extended hepatectomy liver dysfunction. Result and conclusion: There was a 10% increase in RL volume. Mean days between CT and PVE were 20 days. No major complications from PVE were observed.

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Assessment of Liver Function Using 99mTc-Mebrofenin Hepatobiliary Scintigraphy in ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy)

Case Reports in Gastroenterology ◽

10.1159/000441385 ◽

2015 ◽

Vol 9 (3) ◽

pp. 353-360 ◽

Cited By ~ 17

Author(s):

Kasia P. Cieslak ◽

Pim B. Olthof ◽

Krijn P. van Lienden ◽

Marc G. Besselink ◽

Olivier R.C. Busch ◽

...

Keyword(s):

Portal Vein ◽

Liver Volume ◽

Postoperative Liver Failure ◽

Portal Vein Ligation ◽

Hepatobiliary Scintigraphy ◽

Remnant Liver ◽

Total Liver Volume ◽

Second Stage ◽

Staged Hepatectomy

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a new surgical technique for patients in whom conventional treatment is not feasible due to insufficient future remnant liver (FRL). During the first stage of ALPPS, accelerated hypertrophy of the FRL is induced by ligation of the portal vein and in situ split of the liver. In the second stage, the deportalized liver is removed when the FRL volume has reached ≥25% of total liver volume. However, FRL volume does not necessarily reflect FRL function. 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) with SPECT-CT is a quantitative test enabling regional assessment of parenchymal uptake function using a validated cut-off value for the prediction of postoperative liver failure (2.7%/min/m2). This paper describes the changes in FRL function and FRL volume in a 79-year-old patient diagnosed with metachronous colonic liver metastases who underwent ALPPS. We have observed a substantial difference between the increase in FRL volume and FRL function suggesting that HBS with SPECT-CT enables monitoring of the FRL function and could be a useful tool in the timing of resection in the second stage of the ALPPS procedure.

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Preoperative right portal vein embolization in patients with metastatic liver disease: Metastatic liver volumes after RPVE

Acta Radiologica ◽

10.1258/rsmacta.44.1.98 ◽

2003 ◽

Vol 44 (1) ◽

pp. 98-102 ◽

Cited By ~ 1

Author(s):

B. Barbaro ◽

C. Di Stasi ◽

G. Nuzzo ◽

M. Vellone ◽

F. Giuliante ◽

...

Keyword(s):

Colorectal Carcinoma ◽

Portal Vein ◽

Liver Metastases ◽

Portal Vein Embolization ◽

Liver Volume ◽

Spiral Ct ◽

Carcinoid Tumors ◽

Remnant Liver ◽

Resected Liver ◽

Metastatic Liver

Purpose: To quantify liver metastases and future remnant liver (FRL) volumes in patients who underwent right portal vein embolization (RPVE) and to evaluate the effects of this procedure on metastase growth. Material and Methods: Nine patients with liver metastases from primary colon (n = 5), rectal lesions (n = 1) and carcinoid tumors (n = 3) underwent spiral CT to evaluate the ratio of the non-tumorous parenchymal volume of the resected liver to that of the whole liver volume (R2). Hand tracing was used to isolate the entire liver, the resected liver and metastase volumes. All patients with R2 > 60% underwent RPVE. Results: FRL exhibited a 101–336 cm3 (average 241 cm3) increase in volume 1 month after RPVE. One patient refused surgery for 2 months and before surgery the increase in volume of the FRL was similar to that of other patients (180.64 cm3). Percent metastases volume from colorectal carcinoma in embolized liver parenchyma increased from 62.4% to 138.4% at 1 month and to 562% at 2 months after RPVE. Metastase volume from carcinoid tumors was unchanged. Conclusion: One month after RPVE, hypertrophy of the FRL is evident. In the embolized liver, there was a progressive increase in metastase volume from colorectal carcinoma while metastase volume from carcinoid tumor was unchanged in embolized and non-embolized liver.

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