A Comparison of Portal Vein Embolization With Poly(2-hydroxyethylmethacrylate) and a Histoacryl/Lipiodol Mixture in Patients Scheduled for Extended Right Hepatectomy

ght hepatectomy and whether it is as effective as the currently used agent (a histoacryl/lipiodol mixture). Two groups of nine patients each scheduled for extended right hepatectomy for primary or secondary hepatic tumor, had right portal vein embolization in an effort to induce future liver remnant (FLR) hypertrophy. One group had embolization with PHEMA, the other one with the histoacryl/lipiodol mixture. In all patients, embolization was performed using the right retrograde transhepatic access. Embolization was technically successful in all 18 patients, with no complication related to the embolization agent. Eight patients of either group developed FLR hypertrophy allowing extended right hepatectomy. Likewise, one patient in each group had recanalization of a portal vein branch. Histology showed that both embolization agents reach the periphery of portal vein branches, with PHEMA penetrating somewhat deeper into the periphery. PHEMA has been shown to be an agent suitable for embolization in the portal venous system comparable with existing embolization agent (histoacryl/lipiodol mixture).

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

Cancers ◽

10.3390/cancers13020200 ◽

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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Right extended hepatectomy for hilar cholangiocarcinoma: A case report

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v9i3.36422 ◽

2020 ◽

Vol 9 (3) ◽

pp. 173-176

Author(s):

Romi Dahal ◽

Krishna Mohan Adhikari ◽

Sumita Pradhan ◽

Ramesh Singh Bhandari

Keyword(s):

Portal Vein ◽

Hilar Cholangiocarcinoma ◽

Hepatic Duct ◽

Future Liver Remnant ◽

Operation Time ◽

Common Hepatic Duct ◽

Right Hepatectomy ◽

Liver Remnant ◽

Extended Right Hepatectomy ◽

The Right

Radical resection in a case of hilar cholangiocarcinoma is the only curative option. However resection in a hilar cholangiocarcinoma is a challenging procedure because of the low resectability rate. Only a few cases of hilar cholangiocarcinoma are operable because of the advanced nature of disease at presentation. Furthermore, the extent of surgery makes it a complicated process to attempt. We recently had a patient who underwent an open extended right hepatectomy and hepaticojejunostomy for a type IIIa hilar cholangiocarcinoma. The tumor was 20 mm in diameter and was located between the right hepatic duct and common hepatic duct. Radiological examination showed that the hepatic artery was not involved but the right portal vein was invaded by the tumor. CT volumetry was done and the future liver remnant was only 20% in the jaundiced patient. Preoperative drainage was done with percutaneous transhepatic biliary drainage from the left side. Portal vein embolization was done to augment future liver remnant to 30%. The patient underwent an extended right hepatectomy (right trisectionectomy combined with caudate lobectomy). The operation time was nearly 300 min, and the intraoperative blood loss was about 500 ml. However, in the postoperative period, the patient developed post hepatic liver failure which was managed successfully with conservative treatment. The postoperative hospital stay was 23 days. The final diagnosis was hilar cholangiocarcinoma with no nodal metastasis (pT2bN0M0) stage II (American Joint Committee on Cancer, AJCC).

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Comparison of Clinical Outcomes following Glue versus Polyvinyl Alcohol Portal Vein Embolization for Hypertrophy of the Future Liver Remnant prior to Right Hepatectomy

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2016.05.023 ◽

2016 ◽

Vol 27 (12) ◽

pp. 1897-1905.e1 ◽

Cited By ~ 16

Author(s):

Arash Jaberi ◽

Sundeep S. Toor ◽

Dheeraj K. Rajan ◽

Oleg Mironov ◽

John R. Kachura ◽

...

Keyword(s):

Portal Vein ◽

Polyvinyl Alcohol ◽

Clinical Outcomes ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Right Hepatectomy ◽

Liver Remnant ◽

The Future

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Preoperative portal vein embolization followed by right hepatectomy to treat a complex common bile duct injury in a 5-year-old child

World Journal of Pediatric Surgery ◽

10.1136/wjps-2018-000033 ◽

2019 ◽

Vol 2 (2) ◽

pp. e000033

Author(s):

Juan Glinka ◽

Rocio Bruballa ◽

Martin de Santibañes ◽

Rodrigo Sanchez Clariá ◽

Victoria Ardiles ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Portal Vein ◽

Portal Vein Embolization ◽

Pediatric Population ◽

Future Liver Remnant ◽

Liver Parenchyma ◽

Definitive Treatment ◽

Right Hepatectomy ◽

Liver Remnant

BackgroundCommon bile duct injuries (CBDIs) remains a rare but serious complication in children undergoing laparoscopic cholecystectomy (LC), with an incidence of 0.44%. In severe lesions, a major liver resection may be necessary as a definitive treatment. The current principles for safe hepatectomy are mainly focused on the liver parenchyma that remains after resection. Therefore, one of the main factors related to posthepatectomy hepatic insufficiency is the quantity and quality of the future liver remnant (FLR). To achieve an optimal FLR, techniques such as portal vein embolization (PVE) are available.Case presentationWe present the case of a 5-year-old child with a severe CBDI after LC, treated with preoperative PVE followed by a right hepatectomy as definitive treatment. No reports of liver resections and PVE are described in the literature concerning the pediatric population.

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The CHOP Study – Cholestatic Influence on Portal Vein Embolization (PVE) Induced Future Liver Remnant (FLR) Hypertrophy – A Maastricht Aachen Analysis

HPB ◽

10.1016/j.hpb.2021.08.128 ◽

2021 ◽

Vol 23 ◽

pp. S734-S735

Author(s):

R. Korenblik ◽

X. Chang ◽

B. Olij ◽

R. Knapen ◽

C. Van der Leij ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Future Liver Remnant ◽

Liver Remnant ◽

Flr Hypertrophy

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“Reversal” ALPPS in patient with hepatocellular carcinoma and liver cirrhosis. First clinical case in Russia

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2021-3-142-148 ◽

2021 ◽

Vol 26 (3) ◽

pp. 142-148

Author(s):

S. E. Voskanyan ◽

V. S. Rudakov ◽

M. V. Shabalin ◽

A. I. Artemyev ◽

A. N. Bashkov ◽

...

Keyword(s):

Portal Vein ◽

Clinical Case ◽

Future Liver Remnant ◽

Portal Vein Ligation ◽

Right Hepatectomy ◽

Portal Branch ◽

Liver Remnant ◽

First Case ◽

The Right ◽

Staged Hepatectomy

Liver resection in patients with HCC is the treatment of choice. In patients with insufficient future liver remnant (FLR) and compensated liver function performing the Associated Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is possible. The classic version of ALPPS consists in ligation of the right branch of the portal vein with transection of the parenchyma and then performing right hepatectomy or right trisegmentectomy. This paper describes the first case in Russia of performing ligation of the left portal branch with transection of the parenchyma and then performing left trisegmentectomy (“reversal” ALPPS) in a patient with HCC and cirrhosis. Reversal ALPPS can be successfully performed in patients with insufficient future liver remnant in well-selected patients.

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