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 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 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 &lt; 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.

Liver venous deprivation compared to portal vein embolization to induce hypertrophy of the future liver remnant before major hepatectomy: A single center experience

Surgery ◽  
2020 ◽  
Vol 167 (6) ◽  
pp. 917-923 ◽  
Author(s):  
Kosuke Kobayashi ◽  
Takamune Yamaguchi ◽  
Alban Denys ◽  
Lindsay Perron ◽  
Nermin Halkic ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Major Hepatectomy ◽  
Future Liver Remnant ◽  
Single Center ◽  
Liver Remnant ◽  
Single Center Experience ◽  
The Future

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.

scholarly journals Oncological Outcomes after Liver Venous Deprivation for Colorectal Liver Metastases: A Single Center Experience

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 200
Author(s):  
Salah Khayat ◽  
Gianluca Cassese ◽  
François Quenet ◽  
Christophe Cassinotto ◽  
Eric Assenat ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Metastases ◽  
Portal Vein Embolization ◽  
Colorectal Liver Metastases ◽  
Future Liver Remnant ◽  
Small Sample ◽  
Right Hepatectomy ◽  
Liver Remnant ◽  
Oncological Outcomes ◽  
Extended Right Hepatectomy

Colorectal liver metastases (CRLM) are the major cause of death in patients with colorectal cancer (CRC). The cornerstone treatment of CRLM is surgical resection. Post-operative morbidity and mortality are mainly linked to an inadequate future liver remnant (FLR). Nowadays preoperative portal vein embolization (PVE) is the most widely performed technique to increase the size of the future liver remnant (FLR) before major hepatectomies. One method recently proposed to increase the FLR is liver venous deprivation (LVD), but its oncological impact is still unknown. The aim of this study is to report first short- and long-term oncological outcomes after LVD in patients undergoing right (or extended right) hepatectomy for CRLM. Seventeen consecutive patients undergoing LVD between July 2015 and May 2020 before an (extended) right hepatectomy were retrospectively analyzed from an institutional database. Post-operative and follow-up data were analyzed and reported. Primary outcomes were 1-year and 3-year overall survival (OS) and hepatic recurrence (HR). Postoperative complications occurred in 8 patients (47%). No deaths occurred after surgery. HR occurred in 9 patients (52.9%). 1-year and 3-year OS were 87% (95% confidence interval [CI]: ±16%) and 60.3%, respectively (95% CI: ±23%). Median Disease-Free Survival (DFS) was 6 months (CI 95%: 4.7–7.2). With all the limitations of a retrospective study with a small sample size, LVD showed similar oncological outcomes compared to literature reports for Portal Vein Embolization (PVE).

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