Induction of hypertrophy of the left hepatic lobe by unilateral right hepatic arterial radioembolization (RE) using 90Y-labeled resin microspheres in patients with right-sided secondary malignant liver tumors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14630-e14630
Author(s):  
Benjamin Garlipp ◽  
Max Seidensticker ◽  
Romy Irmscher ◽  
Robert Damm ◽  
Jens Ricke ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Liver Surgery ◽  
Liver Tumors ◽  
Prospective Trial ◽  
Future Liver Remnant ◽  
Similar Degree ◽  
Simultaneous Treatment ◽  
Liver Remnant ◽  
Resin Microspheres ◽  
Liver Cancers

e14630 Background: In patients with unilateral liver tumors who are candidates for extended liver resection but demonstrate insufficient future liver remnant (FLR) size, induction of FLR hypertrophy by contralateral portal vein embolization (PVE) is an established approach but concerns exist regarding tumor progression during the interval from PVE to liver surgery. We hypothesized that unilateral hepatic arterial radioembolization (RE) using 90Y-labelled resin microspheres achieves a similar degree of contralateral hypertrophy as PVE. Methods: 32 patients with right-sided secondary liver cancers (metastases from colorectal [n=20], breast [n=7], head and neck [n=2], and other [n=3] cancers) were treated with unilateral right hepatic arterial RE. Before and 44 (22-81) days following RE MRI-based volumetry of the total liver (TLV), the right (RLV, segments 4-8) and left (LLV, segments 2 and 3) hepatic lobes was performed. TLV, RLV, and LLV as well as the LLV/TLV ratio before and after RE were compared using the Mann-Whitney U-test. Results: Median values for TLV, RLV, LLV, and the LLV/TLV ratio are shown in table. Compared to baseline, RLV and TLV showed no significant change after right hepatic arterial RE (-3.7 [min/max, -37.7/+56.5] per cent [p=0.158] and +3.2 [-16.5/+47.4] per cent [p=0.282], respectively). In contrast, LLV as well as the LLV/TLV ratio were significantly increased after RE (+34.9 [-3.1/+146.2] per cent [p<0.001] and +29.4 [-24.3/+155.3] per cent [p<0.001], respectively). Conclusions: Right hepatic arterial RE achieved superior contralateral liver hypertrophy compared to hypertrophy reported after PVE and may be an alternative to PVE since it provides simultaneous treatment to the liver tumors during the interval from treatment to liver surgery, reducing the risk for tumor progression. These two methods should be directly compared within a prospective trial. [Table: see text]

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

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.

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 Advances in the conventional clinical treatment for hepatoblastoma and therapeutic innovation

2021 ◽  
Vol 4 (3) ◽  
pp. e000220
Author(s):  
Zhixue Chen ◽  
Rui Dong
Keyword(s):  
Liver Transplantation ◽  
Clinical Trials ◽  
Portal Vein ◽  
Molecular Mechanisms ◽  
Liver Tumors ◽  
Surgical Techniques ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
New Treatments

BackgroundHepatoblastoma (HB) is a rare malignancy usually occurring in children under 3 years old. With advancements in surgical techniques and molecular biology, new treatments have been developed.Data resourcesThe recent literatures on new treatments, molecular mechanisms and clinical trials for HB were searched and reviewed.ResultsSurgical resection remains the main option for treatment of HB. Although complete resection is recommended, a resection with microscopical positive margins (R1) may have similar 5-year overall survival and 5-year event-free survival (EFS) rates after cisplatin chemotherapy and the control of metastasis, as only once described so far. Indocyanine green-guided surgery can help achieve precise resection. Additionally, associating liver partition and portal vein ligation for staged hepatectomy can rapidly increase future liver remnant volume compared with portal vein ligation or embolization. Cisplatin-containing chemotherapies slightly differ among the guidelines from the International Childhood Liver Tumors Strategy Group (SIOPEL), Children’s Oncology Group (COG) and Chinese Anti-Cancer Association Pediatric Committee (CCCG), and the 3-year EFS rate of patients in SIOPEL and CCCG studies was recently shown to be higher than that in COG studies. Liver transplantation is an option for patients with unresectable HB, and successful cases of autologous liver transplantation have been reported. In addition, effective inhibitors of important targets, such as the mTOR (mammalian target of rapamycin) inhibitor rapamycin, β-catenin inhibitor celecoxib and EpCAM (epithelial cell adhesion molecule) inhibitor catumaxomab, have been demonstrated to reduce the activity of HB cells and to control metastasis in experimental research and clinical trials.ConclusionThese advances in surgical and medical treatment provide better outcomes for children with HB, and identifying novel targets may lead to the development of future targeted therapies and immunotherapies.

scholarly journals Revisión histórico - narrativa del ALPPS

2021 ◽  
Vol 113 (1) ◽  
pp. 43-55
Author(s):  
José R. Oliver Guillén ◽  
◽  
José M. Ramia Ángel ◽  
Mario Serradilla Martín ◽  
Keyword(s):  
Observational Studies ◽  
Liver Tumors ◽  
Future Liver Remnant ◽  
Historical Review ◽  
Current Evidence ◽  
High Morbidity ◽  
International Expert ◽  
Biliary Surgery ◽  
Liver Remnant ◽  
Technical Modifications

Two-stage liver resections were described to increase the resectability of liver tumors in patients with insufficient future liver remnant. The ALPPS procedure, described in 2011, has represented a breakthrough in the field of hepato-pancreato-biliary surgery. This technique accelerates the hypertrophy of the future liver remnant and reduces the interval between the two surgeries compared with previous techniques. ALPPS has gained popularity rapidly, with more than 1200 patients included in the world registry. Recommendations about indications, patient selection and surgical standardization have been discussed twice in international expert meetings. Although ALPPS has proven to be superior in terms of resectability (80-100% versus 60-90% of twostage hepatectomy), its rapid implementation has been punished with high morbidity and mortality reaching up to 40% and 9%, respectively, in the published series. The current evidence on the possible benefits and disadvantages is mainly based on observational studies. We present a historical review, describing the different technical modifications that have been carried out since its description, with a rigorous review in terms of morbidity, mortality, and oncological outcomes.

scholarly journals The comparison of central hepatic segments resection versus extended hepatectomies outcomes in children with liver tumors

2021 ◽  
Vol 26 (1) ◽  
pp. 76-83
Author(s):  
D. G. Akhaladze ◽  
G. S. Rabaev ◽  
N. G. Uskova ◽  
N. N. Merkulov ◽  
S. R. Talypov ◽  
...  
Keyword(s):  
Operative Time ◽  
Liver Tumors ◽  
Future Liver Remnant ◽  
Transfusion Rate ◽  
Safe Procedure ◽  
Liver Remnant ◽  
Future Liver Remnant Volume ◽  
Central Hepatectomy ◽  
Liver Remnant Volume ◽  
Median Operative Time

Aim. To analyze the safety and advantages of central resection in comparison with extended hepatectomies.   Methods. From June 2017 to May 2020 29 central and extended liver resections for children were performed. Central hepatic resections were carried out in 8, extended hepatectomies – in 21 patients. Preoperative investigations, intraoperative and postoperative data in both groups were analyzed.Results. The main indication for surgery was hepatoblastoma. Future liver remnant volume was significantly higher in central resections group (р = 0.003). No difference in median operative time (р = 0.94), intraoperative blood loss (р = 0.078) and blood transfusion rate (р = 0.057) were found between groups. There were no postoperative complications difference. Also no difference in hospital stay length (р = 0.3) were found.Conclusion. In comparison with extended procedures, central liver resection has similar complication rate. Central hepatectomy is a safe procedure in children with liver tumors, which allows to preserve more healthy parenchyma.

scholarly journals Surgery for liver tumors that are close to major vascular structures of future liver remnant

2019 ◽  
Vol 3 (4) ◽  
pp. 86-91
Author(s):  
Venu Madhav Thumma ◽  
Surya Rama Chandra Varma Gunturi ◽  
Nava Kishore K ◽  
Jagan Mohan Reddy B ◽  
N Bheerappa
Keyword(s):  
Liver Tumors ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Vascular Structures

scholarly journals ALPPS readdresses the management of advanced liver tumors

2017 ◽  
Vol 4 (3) ◽  
pp. 846 ◽  
Author(s):  
Fa-guang Huang ◽  
Jiang-Hua Xiao ◽  
Jun Kong ◽  
Jian Ping Gong
Keyword(s):  
Portal Vein ◽  
Liver Tumors ◽  
Future Liver Remnant ◽  
Oncological Outcome ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Staged Hepatectomy

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been developed to induce rapid liver hypertrophy of the future liver remnant (FLR) prior to hepatectomy in primarily non-resectable or marginally resectable liver tumors. In recent years, this novel strategy has aroused interests of many liver surgeons. Its indications have been broadened gradually with more and more reported cases. Modified ALPPS is also developed to reduce morbidity and mortality. The authors searched Medline and PubMed to identify related articles published in English, using terms: “ALPPS, associating liver partition and portal vein ligation for staged hepatectomy, in situ split, in situ splitting, liver partition”. The authors summarized and analysed the superiority, indications, modifications, safety, mechanisms of regeneration of ALPPS. ALPPS was more effective than traditional portal vein embolization (PVE) or portal vein ligation (PVL). ALPPS obtained 80% volume increase of future liver remnant (FLR ) within 7 days in contrast to 10%-46% within 2 to 8 weeks by PVE or PVL. ALPPS opens a chapter in the history of liver surgery and readdresses the management of advanced primary and metastatic liver tumors. The high morbidity and mortality associated with ALPPS could be decreased remarkably if we carefully select patients and carry out the operation with experienced surgeons. In addition, the safety, mechanisms and oncological outcome of ALPPS are still not clear, which need further research and randomized controlled trials.

scholarly journals The role of hepatobiliary scintigraphy combined with spect/ct in predicting severity of liver failure before major hepatectomy: a single-center pilot study

2020 ◽  
Author(s):  
Matteo Serenari ◽  
Chiara Bonatti ◽  
Lucia Zanoni ◽  
Giuliano Peta ◽  
Elena Tabacchi ◽  
...  
Keyword(s):  
Liver Failure ◽  
Liver Surgery ◽  
Clinical Management ◽  
Major Hepatectomy ◽  
Photon Emission ◽  
Future Liver Remnant ◽  
Emission Computed Tomography ◽  
Hepatobiliary Scintigraphy ◽  
Liver Remnant

Abstract Hepatobiliary scintigraphy (HBS) has been demonstrated to predict post-hepatectomy liver failure (PHLF). However, existing cutoff values for future liver remnant function (FLR-F) were previously set according to the “50–50 criteria” PHLF definition. Methods of calculation and fields of application in liver surgery have changed in the meantime. The aim of this study was to demonstrate the role of HBS combined with single photon emission computed tomography (SPECT/CT) in predicting severity of PHLF, according to the International Study Group of Liver Surgery (ISGLS). All patients submitted to major hepatectomy with preoperative HBS-SPECT/CT between November 2016 and December 2019, were analyzed. Patients were resected according to hepatic volumetry. Receiver operating characteristic (ROC) curve analysis was performed to identify cutoffs of FLR function for predicting PHLF according to ISGLS definition and grading. Of the 38 patients enrolled, 26 were submitted to one-stage hepatectomy (living liver donors = 4) and 12 to two-stage procedures (portal vein embolization = 4, ALPPS = 8). Overall, 18 patients developed PHLF according to ISGLS criteria: 12 of grade A (no change in the patient’s clinical management) and 6 of grade B (change in clinical management). ROC analysis established increasingly higher cutoffs of FLR-F for predicting PHLF according to the “50–50 criteria”, ISGLS grade B and ISGLS grade A/B, respectively. HBS with SPECT/CT may help to assess severity of PHLF following major hepatectomy. Prospective multicenter trials are needed to confirm the effective role of HBS-SPECT/CT in liver surgery.

scholarly journals Intraoperative Conversion to ALPPS in a Case of Intrahepatic Cholangiocarcinoma

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
F. Oldhafer ◽  
K. I. Ringe ◽  
K. Timrott ◽  
M. Kleine ◽  
W. Ramackers ◽  
...  
Keyword(s):  
Liver Resection ◽  
Ct Scan ◽  
Treatment Option ◽  
Intrahepatic Cholangiocarcinoma ◽  
Liver Tumors ◽  
Future Liver Remnant ◽  
Portal Vein Ligation ◽  
Liver Remnant ◽  
Typical Lesion ◽  
Intraoperative Conversion

Background. Surgical resection remains the best treatment option for intrahepatic cholangiocarcinoma (ICC). Two-stage liver resection combiningin situliver transection with portal vein ligation (ALPPS) has been described as a promising method to increase the resectability of liver tumors also in the case of ICC.Presentation of Case. A 46-year-old male patient presented with an ICC-typical lesion in the right liver. The indication for primary liver resection was set and planed as a right hepatectomy. In contrast to the preoperative CT-scan, the known lesion showed further progression in a macroscopically steatotic liver. Therefore, the decision was made to perform an ALPPS-procedure to avoid an insufficient future liver remnant (FLR). The patient showed an uneventful postoperative course after the first and second step of the ALPPS-procedure, with sufficient increase of the FLR. Unfortunately, already 2.5 months after resection the patient had developed new tumor lesions found by the follow-up CT-scan.Discussion. The presented case demonstrates that an intraoperative conversion to an ALPPS-procedure is safely applicable when the FLR surprisingly seems to be insufficient.Conclusion. ALPPS should also be considered a treatment option in well-selected patients with ICC. However, the experience concerning the outcome of ALPPS in case of ICC remains fairly small.

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