Ultrasonography-guided Suction Thrombectomy for an Isolated Portal Vein Thrombus in Liver Surgery

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.

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Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): A new strategy to increase resectability in liver surgery

International Journal of Surgery ◽

10.1016/j.ijsu.2014.03.009 ◽

2014 ◽

Vol 12 (5) ◽

pp. 437-441 ◽

Cited By ~ 38

Author(s):

Guan-Qi Zhang ◽

Zhi-Wei Zhang ◽

Wan-Yee Lau ◽

Xiao-Ping Chen

Keyword(s):

Portal Vein ◽

Liver Surgery ◽

Portal Vein Ligation ◽

New Strategy ◽

Staged Hepatectomy

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A phase I/II trial of NBTXR3 nanoparticles activated by SBRT in the treatment of liver cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.tps551 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. TPS551-TPS551 ◽

Cited By ~ 2

Author(s):

Enrique Chajon ◽

Marc Pracht ◽

Thierry De Baere ◽

France Nguyen ◽

Jean-Pierre Bronowicki ◽

...

Keyword(s):

Adverse Event ◽

Portal Vein ◽

Phase I ◽

Hafnium Oxide ◽

Local Treatment ◽

Complete Response ◽

High Electron ◽

Portal Vein Thrombus ◽

Primary Endpoints ◽

Liver Cancers

TPS551 Background: A new class of material with high electron density, hafnium oxide, was designed at the nanoscale (NBTXR3) to efficiently enhance the energy dose deposit from within the tumor cells and increase lethality of tumors, when exposed to radiotherapy (RT). The physical mode of action of NBTXR3 may represent a breakthrough approach for the local treatment of liver cancers, as it does not engage liver and renal functions, i.e. nanoparticles are not metabolized and not excreted by kidney. A phase I/II trial has been implemented for the treatment of hepatocellular carcinoma and liver metastasis [NCT02721056]. The study is currently recruiting patients. Methods: Patients (pts) receive a single intralesional (IL) injection of NBTXR3 (53.3g/L) at Volume levels equivalent to 10%, 15%, 22% and 33% of the baseline tumor volume, followed by RT (SBRT, 45Gy / 3 fractions / 5 to 7 days). For the Phase I part, primary endpoints include determination of the Recommended Dose and Dose Limiting Toxicities (DLT). The Phase II part will test three different groups of patients, HCC with portal vein thrombus, HCC without portal vein thrombus and a third cohort with liver metastases. Primary endpoints are complete response rate and safety. Results: Enrollment was completed for Volume levels 10% (6 pts) and 15% (4 pts) and is currently recruiting patients at 22% level. The NBTXR3 injections were successful in all cases. Radiotherapy has been delivered as planned without any DLT occurrence. No serious adverse event (SAE) related to NBTXR3 or the treatment procedure occurred. Three adverse events related to the injection were reported and no adverse event related to NBTXR3. Importantly, NBTXR3 nanoparticles did not have any impact on the reliability of image-guided radiation therapy (IGRT). Conclusion: The injection of NBTXR3 was safe and well tolerated at these levels. Patients received the planned RT. No DLT occurred. Enrollment is now opened at the 22% level. NBTXR3 shows promising results in terms of safety and antitumor activity and is also currently evaluated in other six clinical studies. Clinical trial information: NCT02721056.

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