scholarly journals 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 ◽  
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.

scholarly journals Hepatic and portal vein embolization before major hepatectomy: An increase of 80% in future liver remnant

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S392
Author(s):  
B. Fernandez ◽  
C. Laurent ◽  
J.P. Adam ◽  
P. Papadopoulos ◽  
B. Lapuyade ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Major Hepatectomy ◽  
Future Liver Remnant ◽  
Liver Remnant

scholarly journals Portal Vein Embolization with PVA and Coils before Major Hepatectomy: Single-Center Retrospective Analysis in Sixty-Four Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
R. Camelo ◽  
J. H. Luz ◽  
F. V. Gomes ◽  
E. Coimbra ◽  
N. V. Costa ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Tumor ◽  
Portal Vein Embolization ◽  
Liver Surgery ◽  
Major Hepatectomy ◽  
Tumor Resection ◽  
Future Liver Remnant ◽  
Mean Value ◽  
Liver Remnant ◽  
Hepatic Artery Branch

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.

scholarly journals Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

2020 ◽  
Vol 27 (7) ◽  
pp. 2311-2318 ◽  
Author(s):  
Pim B. Olthof ◽  
◽  
Luca Aldrighetti ◽  
Ruslan Alikhanov ◽  
Matteo Cescon ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Liver Failure ◽  
Portal Vein Embolization ◽  
Future Liver Remnant ◽  
International Study ◽  
Perihilar Cholangiocarcinoma ◽  
Major Liver Resection ◽  
Biliary Leakage ◽  
Liver Remnant

Abstract Background Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p < 0.001 and p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p < 0.001), as was biliary leakage (10% vs. 35%, p < 0.01), intra-abdominal abscesses (19% vs. 34%, p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.

scholarly journals Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes

2020 ◽  
Vol 9 (5) ◽  
pp. 564-576 ◽  
Author(s):  
Boris Guiu ◽  
François Quenet ◽  
Fabrizio Panaro ◽  
Lauranne Piron ◽  
Christophe Cassinotto ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Major Hepatectomy ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Functional Changes

scholarly journals Analysis of Portal Vein Embolization Using Absolute Ethanol Before Major Hepatectomy

2016 ◽  
Vol 101 (9-10) ◽  
pp. 453-457
Author(s):  
Yuta Yamamoto ◽  
Motohiro Mihara ◽  
Takahiro Yoshizawa ◽  
Shinsuke Sugenoya ◽  
Arano Makino ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Major Hepatectomy ◽  
Future Liver Remnant ◽  
Absolute Ethanol ◽  
Time Interval ◽  
Remnant Liver ◽  
Iodized Oil ◽  
Liver Remnant ◽  
The Mean

Portal vein embolization (PVE) is widely considered to improve the safety and extend the indication of major hepatectomy. There are various embolization materials and techniques in each facility. The safety and efficacy of absolute ethanol (EOH) in PVE were analyzed. Fifty-one patients who underwent PVE prior to major hepatectomy were enrolled in this study. Two types of embolization techniques were performed: transileocolic portal vein embolization (TIPE) and percutaneous transhepatic portal vein embolization (PTPE). The embolization material consisted of 20 mL of EOH and 2 mL of iodized oil. Multislice computed tomography (CT) scans were performed before and after PVE. The mean time interval between PVE and the follow-up CT scan was 16.3 ± 5.0 days. The mean future liver remnant ratio to total liver (FLR%) significantly increased from 32.1% ± 7.6% to 43.5% ± 9.5% after PVE (P &lt; 0.001). The mean hypertrophy ratio was 41.1% ± 34.5%. There were 3 major complications, subcutaneous hematoma in the TIPE group, hemobilia, and bile leakage in the PTPE group. Although the levels of aspartate transaminase and alanine transaminase increased dramatically after PVE, they subsequently returned to pre-PVE levels. There were no patients whose liver dysfunction was prolonged until hepatectomy. In conclusion, PVE using EOH is a safe and effective method to induce hypertrophy in the future remnant liver before major hepatectomy.

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