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

2003 ◽  
Vol 44 (1) ◽  
pp. 98-102 ◽  
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.

scholarly journals Increasing the remnant liver volume using portal vein embolization

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.

scholarly journals Right hepatectomy with preservation of the entire caudate lobe in patients with metastatic liver tumors: a case of a new hepatectomy technique and treatment strategy for patients with marginal liver function

BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Hiroyuki Kato ◽  
Yukio Asano ◽  
Masahiro Ito ◽  
Satoshi Arakawa ◽  
Norihiko Kawabe ◽  
...  
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Indocyanine Green ◽  
Liver Volume ◽  
Caudate Lobe ◽  
Remnant Liver ◽  
Right Hepatectomy ◽  
Indocyanine Green Clearance ◽  
The Right ◽  
Metastatic Liver

Abstract Background Performing major hepatectomy for patients with marginal hepatic function is challenging. In some cases, the procedure is contraindicated owing to the threat of postoperative liver failure. In this case report, we present the first case of marginal liver function (indocyanine green clearance retention rate at 15 min [ICGR15]: 28%) successfully treated with right hepatectomy, resulting in total caudate lobe preservation. Case presentation A 71-year-old man was diagnosed with sigmoid colon cancer with three liver metastases (S5, S7, and S8). All of metastatic lesions shrunk after chemotherapy, but his ICGR15 and indocyanine green clearance rate (ICGK) were 21% and 0.12, respectively. Moreover, the remnant liver volume was only 39%. Therefore, portal venous embolism (PVE) of the right portal vein was suggested. Portography showed divergence of the considerably preserved right caudate lobe branch (PV1R) from the root of the right portal vein. The liver function was reevaluated 18 days after PVE was suggested. During this time, the ICGR15 (21–28%) and ICGK rate (0.12–0.10) deteriorated. The right caudate lobe was significantly enlarged; thus, a total caudate lobe-preserving hepatectomy (TCPRx) was performed. Patients eligible for TCPRx included those with (1) hepatocellular carcinoma or metastatic liver cancer, (2) no tumor in the caudate lobe, (3) marginal liver function (ICG Krem greater than 0.05 if TCPRx was adapted; otherwise, less than 0.05) and Child–Pugh classification category A, and (4) preserved PV1R and right caudate bile duct branch. The procedure was performed through (A) precise estimation of the remnant liver volume preoperatively, (B) repeated intraoperative cholangiography to confirm the biliary branch of the right caudate lobe (B1R) conservation, and (C) stapler division of posterior and anterior Glisson’s pedicles laterally to avoid injuries to the PV1R and B1R. Conclusions Right hepatectomy with total caudate lobe preservation, following PVE, was a safe and viable surgical technique for patients with marginal liver function.

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

2001 ◽  
Vol 120 (5) ◽  
pp. A90
Author(s):  
Christian Hillert ◽  
Dieter C. Broering ◽  
Gerrit Krupski ◽  
Matthias Gundlach ◽  
Xavier Rogiers
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Portal Vein Ligation ◽  
Remnant Liver ◽  
Remnant Liver Volume

Multiple utilities of portal vein embolization for patients with hepatocellular carcinoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 319-319
Author(s):  
Toru Beppu ◽  
Hirohisa Okabe ◽  
Kazutoshi Okabe ◽  
Toshiro Masuda ◽  
Kosuke Mima ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Disease Free Survival ◽  
Remnant Liver ◽  
Right Hepatectomy ◽  
Tace Group ◽  
Disease Free

319 Background: Portal vein embolization (PVE) is a multi-potential treatment for hepatocellular carcinoma (HCC). The aim of this study is to identify the efficacies of PVE for resectable and unresectable HCC patients. Methods: Until 2011, 668 HCC patients underwent hepatic resection and 102 HCC patients treated with PVE. PVE was performed with percutaneous and ipsilateral approach using ethanolamine oleate iopamidol. Preoperative future remnant liver volume (%LV) and functional liver volume (%FLV ) were assessed with our developed combined 99mTc- galactosyl human serum albumin (GSA) scintigraphy (SPECT)/CT system. In unresectable cases chemoembolization (TACE) was repeated after PVE. Results: 1. Comparison of %LV and %FLV after right-PVE (n=40). %FLV before PVE was significantly lower in PVE group (38%) compared to non-PVE group (58%), but increased remarkably after PVE (from 38% to 55%, P < 0.0001). Right hepatectomy was successfully completed in 10 patients based on %FLV, instead of conventional %LV. 2. Long-term prognosis after right-hepatectomy with /without PVE (n=60). The 3- and 5-year disease-free survival (DFS) rates in the PVE group were significantly greater than those in the non-PVE group (78% and 78% versus 20% and 0%, P = 0.01). The 3- and 5-year overall survival (OS) rates in the PVE group were also higher than those in the non-PVE group (72% and 72% versus 57% and 12%, P <0.05). By multivariate analysis, independent prognostic factors for DFS were application of PVE (HR3.59), Multiple tumor (HR3.57), Fibrosis stage F3–4 (HR2.81), and protein induced by vitamin K absence or antagonists-II (PIVKA-II) ≥678AU/ml (HR2.69). 3. Prevention of intrahepatic metastases in unresectable HCCs in hemi-liver (n=40). The 3-year intrahepatic recurrence rates in the non-portal-embolized area was 58.8% and 81.8%, and the 5-year OS was 38.2% and 8.5%, in the PVE/TACE group and TACE group, respectively. The former rates were sinificantly higher (P<0.05). Conclusions: PVE can improve resectability, and might improve disease-free and overall survival for patients with both resectable and unresectable HCC.

Liver Regeneration and Recanalization Time Course following Repeated Reversible Portal Vein Embolization in Swine

2020 ◽  
Vol 61 (2-3) ◽  
pp. 62-71
Author(s):  
Martin Gaillard ◽  
Emmanuel Hornez ◽  
Benoit Lecuelle ◽  
Thomas Lilin ◽  
Anne Dubart-Kupperschmitt ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Large Animal Model ◽  
Gelatin Sponge ◽  
Large Animal ◽  
Remnant Liver ◽  
Total Liver Volume ◽  
Absorbable Material ◽  
Total Liver

<b><i>Introduction:</i></b> Portal vein embolization (PVE) is an accepted technique to preoperatively increase the volume of the future remnant liver before major hepatectomy. A permanent material is usually preferred since its superiority to induce liver hypertrophy over absorbable material has been demonstrated. Nevertheless, the use of an absorbable material generates a reversible PVE (RPVE) capable of inducing significant liver hypertrophy. In small animal models, the possibility to proceed to a repeated RPVE (RRPVE) has shown to boost liver hypertrophy further. The aim of this preliminary study was to assess the feasibility and the tolerance of RRPVE in a large animal model, in comparison with permanent PVE (PPVE) and single RPVE. <b><i>Methods:</i></b> Six swine (2 per group) were assigned either to single RPVE group (using powdered gelatin sponge), RRPVE group (2 RPVEs separated by 14 days) or PPVE group (using N-butyl-cyanoacrylate). The feasibility and tolerance of the procedures were evaluated using portography, liver function tests and histological analysis. Evolution of liver volumes was assessed with volumetric imaging by computed tomography. <b><i>Results:</i></b> Embolization of portal branches corresponding to 75% of total liver volume was performed successfully in all animals. Procedures were well tolerated, inducing moderate changes in portal pressure and transient aminotransferase increase. None of the animals developed portal vein thrombosis. After RPVE, complete recanalization occurred at day 11. RRPVE showed a trend for higher hypertrophy, the non-embolized liver to total liver ratio reaching 5.2 ± 1.0% in the RPVE group, 6.8 ± 0.1% in the RRPVE group and 5.0 ± 0.3% in the PPVE group. <b><i>Discussion/Conclusion:</i></b> In this preliminary comparative study, RRPVE was as feasible and as well tolerated as the other procedures, and resulted in higher liver hypertrophy.

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