Portal vein ligation with alcohol injection – our first experiences

Introduction: Surgical resection of colorectal liver metastases is a gold standard treatment. The indication criteria still continue expanding. The future liver remnant volume (FLRV) remains the only limiting factor of the resection. Many methods have been discussed to increase the FLRV. Injection of absolute alcohol into the portal vein seems to be one of the most effective. Patients and methods: In 2018 we perioperatively injected 25 ml of absolute alcohol into the ligated right portal branch in 3 patients with colorectal liver metastases at our department. All patients were indicated for second-stage right hemihepatectomy. Results: The mean FLRV increase was 206.6 cm3 4−6 weeks after absolute alcohol injection. A transient elevation of transaminases was observed with spontaneous regression within 10 days from alcohol injection. There was no complication clearly associated with alcohol application. No liver failure was observed. No patient died. All three patients underwent second-stage right hemihepatectomy. Conclusion: Portal vein ligation with alcohol injection can be an uncomplicated and highly effective method to achieve FLRV hypertrophy.

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Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Digestive Surgery ◽

10.1159/000488097 ◽

2018 ◽

Vol 35 (4) ◽

pp. 294-302 ◽

Cited By ~ 8

Author(s):

Hauke Lang ◽

Janine Baumgart ◽

Jens Mittler

Keyword(s):

Portal Vein ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Tumor Recurrence ◽

Controlled Trial ◽

Future Liver Remnant ◽

Portal Vein Ligation ◽

Liver Remnant ◽

Long Term Outcome ◽

Staged Hepatectomy

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has expanded the surgical armamentarium for patients with advanced and bilateral colorectal liver metastases. However, the enthusiasm that the medical fraternity had about ALPPS was hampered by a high mortality rate and early and frequent tumor recurrence. While surgical safety has improved, mainly due to technical refinements and a better patient selection, the oncological value in the face of early tumor recurrence remains unclear. The only randomized controlled trial on ALPPS versus two-stage hepatectomy (TSH) so far confirmed that ALPPS led to higher resectability with comparable perioperative complication rate, but oncological outcome was not measured. Robust data regarding long-term outcome are still missing. TSH and ALPPS might be complementary strategies for the resection of colorectal liver metatsases (CRLM) with ALPPS being reserved for patients with no other surgical option, that is, after failed portal vein embolization or those with an extremely small future liver remnant. In other words, ALPPS can be considered a supplementary tool and a last resort in the liver surgeon’s hand to offer resectability in otherwise nonresectable CRLM. In these individual cases, and always embedded into a multimodal treatment setting, ALPPS may offer a chance of complete tumor removal and prolonged survival and even a chance for cure.

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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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Future Liver Remnant (FLR) Increase in Patients with Colorectal Liver Metastases Is Highest the First Week After Portal Vein Occlusion

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-018-4031-3 ◽

2018 ◽

Vol 23 (3) ◽

pp. 556-562 ◽

Cited By ~ 1

Author(s):

Kristina Hasselgren ◽

Per Sandström ◽

Bård Ingvald Røsok ◽

Ernesto Sparrelid ◽

Gert Lindell ◽

...

Keyword(s):

Portal Vein ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Future Liver Remnant ◽

Liver Remnant ◽

Portal Vein Occlusion ◽

Vein Occlusion

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Kinetic Growth Rate after Portal Vein Embolization Predicts Posthepatectomy Outcomes: Toward Zero Liver-Related Mortality in Patients with Colorectal Liver Metastases and Small Future Liver Remnant

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2012.10.018 ◽

2013 ◽

Vol 216 (2) ◽

pp. 201-209 ◽

Cited By ~ 152

Author(s):

Junichi Shindoh ◽

Mark J. Truty ◽

Thomas A. Aloia ◽

Steven A. Curley ◽

Giuseppe Zimmitti ◽

...

Keyword(s):

Growth Rate ◽

Portal Vein ◽

Liver Metastases ◽

Portal Vein Embolization ◽

Colorectal Liver Metastases ◽

Future Liver Remnant ◽

Liver Remnant ◽

Kinetic Growth ◽

Related Mortality

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Future liver remnant (FLR) increase in patients with colorectal liver metastases is highest the first week after portal vein occlusion

HPB ◽

10.1016/j.hpb.2018.06.2557 ◽

2018 ◽

Vol 20 ◽

pp. S342

Author(s):

K. Hasselgren ◽

P. Sandström ◽

B. Røsok ◽

E. Sparrelid ◽

G. Lindell ◽

...

Keyword(s):

Portal Vein ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Future Liver Remnant ◽

Liver Remnant ◽

Portal Vein Occlusion ◽

Vein Occlusion

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Portal vein embolization with stem cells application for increasing future liver remnant volume in primary non-resectable colorectal liver metastases

HPB ◽

10.1016/j.hpb.2019.10.1319 ◽

2019 ◽

Vol 21 ◽

pp. S989

Author(s):

V. Treska ◽

J. Fichtl ◽

D. Lysak ◽

J. Bruha ◽

P. Duras ◽

...

Keyword(s):

Stem Cells ◽

Portal Vein ◽

Liver Metastases ◽

Portal Vein Embolization ◽

Colorectal Liver Metastases ◽

Future Liver Remnant ◽

Liver Remnant ◽

Future Liver Remnant Volume ◽

Liver Remnant Volume

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Growth of colorectal liver metastases is not accelerated by intraportal administration of stem cells after portal vein embolization

Perspectives in Surgery ◽

10.33699/pis.2019.98.4.159-166 ◽

2019 ◽

Vol 98 (4) ◽

pp. 159-166

Keyword(s):

Stem Cells ◽

Portal Vein ◽

Liver Metastases ◽

Portal Vein Embolization ◽

Colorectal Liver Metastases ◽

Future Liver Remnant ◽

Liver Remnant ◽

Hematopoietic Stem ◽

Significant Difference ◽

Extrahepatic Metastases

Introduction: Future liver remnant volume (FLRV) is a crucial factor impacting resectability of colorectal liver metastases (CLM). In case of low FLRV, augmentation can be done by performing portal vein embolization (PVE). However, there is a risk of progression of CLM between PVE and resection. Intraportal application of autologous hematopoietic stem cells (HSC) is a possibility to accelerate the growth of FLRV. The effect of thus applied SC on CLM progression still remains unclear, though. Methods: 63 patients underwent PVE between 2003 and 2015. In 20 patients a product with HSC was applied intraportally on the first day after PVE (PVE HSC group). HSC were gained from peripheral blood (10 patients) or bone marrow (10 patients). FLRV and volume of liver metastases (VLM) were evaluated by CT volumetry. The gained data were statistically evaluated in relation to the disease free interval (DFI), overall survival (OS), achievement of CLM resectability and progression of extrahepatic metastases. We compared the PVE HSC group with the group of patient undergoing simple PVE. Results: No significant difference in FLRV and VLM growth was observed between the study groups. The percentage of exploratory laparotomies was smaller in the group with PVE and HSC application. Patients with simple PVE had a significantly higher incidence of extrahepatic metastases during follow up. We did not observe any significant differences in DFI and OS between the groups. Conclusion: HSC application did not accelerate CLM growth in comparison with PVE alone. PVE and HSC application had a higher percentage of patients undergoing liver resection and a lower incidence of extrahepatic metastases.

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