Effect of Preoperative Portal Vein Embolization on Liver Volume and Hepatic Energy Status of the Nonembolized Liver Lobe in Humans

Background In patients with bilobar metastatic liver disease, surgical clearance of both liver lobes may be achieved through multiple-stage liver resections. For patients with extensive disease, a major two-staged hepatectomy consisting of resection of liver segments II and III before right-sided portal vein embolization (PVE) and resection of segments V–VIII may be performed, leaving only segments IV ± I as the liver remnant. Purpose To describe the outcome following right-sided PVE after prior complete resection of liver segments II and III. Material and Methods In this retrospective study, 15 patients (mean age = 60.4 ± 9.3 years) with liver metastases from colorectal cancer (n = 14) and uveal melanoma (n = 1) who were scheduled to undergo a major two-stage hepatectomy, were included. Total liver volume (TLV) and volume of the future liver remnant (FLR) were measured on pre- and postinterventional computed tomography (CT) scans, and standardized FLR volumes (ratio FLR/TLV) were calculated. Patient data were retrospectively analyzed regarding peri- and postinterventional complications, with special emphasis on liver function tests. Results The mean standardized post-PVE FLR volume was 26.9% ± 6.4% and no patient developed hepatic insufficiency after the PVE. Based on FLR hypertrophy and liver function tests, all but one patient were considered eligible for the subsequent right-sided hepatectomy. However, due to local tumor progression, only 9/15 patients eventually proceeded to the second stage of surgery.   Conclusion Right-sided PVE was safe and efficacious in this cohort of patients who had previously undergone a complete resection of liver segments II and III as part of a major staged hepatectomy pathway leaving only segments IV(±I) as the FLR. 

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Volume Change and Liver Parenchymal Signal Intensity in Gd-EOB-DTPA-Enhanced Magnetic Resonance Imaging after Portal Vein Embolization prior to Hepatectomy

BioMed Research International ◽

10.1155/2014/684754 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Ayako Akiba ◽

Satoru Murata ◽

Takahiko Mine ◽

Shiro Onozawa ◽

Tetsuro Sekine ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Portal Vein ◽

Volume Change ◽

Portal Vein Embolization ◽

Liver Volume ◽

Resonance Imaging ◽

Ct Volumetry ◽

Liver Remnant ◽

Enhanced Mri

Purpose.To investigate the liver volume change and the potential of early evaluation by contrast-enhanced magnetic resonance imaging (MRI) using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) after portal vein embolization (PVE).Materials and Methods.Retrospective evaluations of computed tomography (CT) volumetry of total liver and nonembolized areas were performed before and 3 weeks after PVE in 37 cases. The percentage of future liver remnant (%FLR) and the change ratio of %FLR (%FLR ratio) were calculated. Prospective evaluation of signal intensities (SIs) was performed to estimate the role of Gd-EOB-DTPA-enhanced MRI as a predictor of hypertrophy in 16 cases. The SI contrast between embolized and nonembolized areas was calculated 1 week after PVE. The change in SI contrast before and after PVE (SI ratio) was also calculated in 11 cases.Results.%FLR ratio significantly increased, and SI ratio significantly decreased (bothP<0.01). There were significant negative correlations between %FLR and SI contrast and between %FLR and SI ratio (bothP<0.01).Conclusion.Hypertrophy in the nonembolized area after PVE was indicated by CT volumetry, and measurement of SI contrast and SI ratio in Gd-EOB-DTPA-enhanced MRI early after PVE may be useful to predict the potential for hepatic hypertrophy.

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Peer review report 2 on "Impact of liver volume and liver function on posthepatectomy liver failure after portal vein embolization- a multivariable cohort analysis"

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2018.03.008 ◽

2018 ◽

Vol 25 ◽

pp. 9

Author(s):

Francisco J. Buils Vilalta

Keyword(s):

Liver Function ◽

Portal Vein ◽

Liver Failure ◽

Peer Review ◽

Portal Vein Embolization ◽

Cohort Analysis ◽

Liver Volume ◽

Posthepatectomy Liver Failure

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Hepatic parenchymal transection increases liver volume but not function after portal vein embolization in rabbits

Surgery ◽

10.1016/j.surg.2016.12.014 ◽

2017 ◽

Vol 162 (4) ◽

pp. 732-741 ◽

Cited By ~ 7

Author(s):

Pim B. Olthof ◽

Erik Schadde ◽

Krijn P. van Lienden ◽

Michal Heger ◽

Kora de Bruin ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Liver Volume ◽

Parenchymal Transection

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Increasing the remnant liver volume using portal vein embolization

Asian Biomedicine ◽

10.2478/abm-2010-0107 ◽

2010 ◽

Vol 4 (5) ◽

pp. 817-820

Author(s):

Thanis Saksirinukul ◽

Permyot Kosolbhand ◽

Natthaporn Tanpowpong

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Major Hepatectomy ◽

Liver Volume ◽

Measurement Methods ◽

Remnant Liver ◽

Extended Hepatectomy ◽

Volumetric Measurement ◽

Common Procedure ◽

Total Liver Volume

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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Hepatic venular resistance responses to norepinephrine, isoproterenol, adenosine, histamine, and ACh in rabbits

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1998.274.3.h777 ◽

1998 ◽

Vol 274 (3) ◽

pp. H777-H785 ◽

Cited By ~ 9

Author(s):

Carl F. Rothe ◽

Roberto Maass-Moreno

Keyword(s):

Blood Flow ◽

Portal Vein ◽

Hepatic Blood Flow ◽

Inferior Vena ◽

Liver Volume ◽

Liver Lobe ◽

Inferior Vena Caval ◽

Total Hepatic Blood Flow ◽

Constant Rate ◽

Increased Blood Flow

Changes in hepatic venous resistance were estimated in rabbits from the hepatic venular-inferior vena caval pressure gradient [servo-null micropipettes in 49 ± 15 (SD) μm vessels] and the total hepatic blood flow (ultrasound probe encircling the hepatic artery and the portal vein). Changes in liver volume, and thus vascular capacitance, were estimated from measures of the liver lobe thickness. Norepinephrine (NE), isoproterenol (Iso), adenosine (Ado), histamine (Hist), or acetylcholine (ACh) was infused into the portal vein at a constant rate for 5 min. NE, Hist, and Ado increased hepatic venular pressure, but only NE and Hist significantly increased hepatic venular resistance. NE reduced the liver thickness, but Hist and Ado caused engorgement. Hepatic blood flow was increased by NE and Ado and decreased by ACh. The influence of intraportal vein infusion of Iso on the liver vasculature, at doses similar to that of NE, was insignificant. We conclude that NE acted on all the hepatic microvasculature, increasing resistance and actively decreasing vascular volume. Hist passively induced engorgement by increasing outflow resistance, whereas the liver engorgement seen with Ado was passively related to the increased blood flow. ACh constricted the portal venules but did not change the liver volume.

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