Efficacy of Pre-Operative Portal Vein Embolization of Biliary Neoplasm before Major Hepatectomy

2021 ◽  
Vol 104 (4) ◽  
pp. 583-590
Keyword(s):  
Portal Vein ◽  
Liver Failure ◽  
Hepatic Resection ◽  
Portal Vein Embolization ◽  
Locally Advanced ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Major Hepatic Resection ◽  
Biliary Neoplasm

Background: Malignant biliary neoplasm is relatively common in Southeast Asia. Portal vein embolization (PVE) is a preoperative procedure to induce hypertrophy of future liver remnants. PVE can decrease the rate of post hepatectomy liver failure (PHLF). Objective: To evaluate the efficacy of preoperative PVE of biliary neoplasm patient prior to major hepatic resection. Materials and Methods: The study included 53 patients with biliary neoplasm planned for major hepatic resection and that underwent PVE between July 2013 and August 2019. Liver volumetry before and after PVE was analyzed. Operative procedure and post hepatectomy outcome were evaluated. Results: Peri-hilar type cholangiocarcinoma, Bismuth-Corlette classification IIIA was the most frequent tumor. The technical success rate of PVE is 100%. Future liver remnant (FLR) volume after PVE was significantly increased from 379.1 to 460 mL (p<0.001). Post PVE FLR over total functional liver volume (TFLV) ratio was significantly increased from 27.8% to 34.6%(p<0.001). The mean kinetic growth rate (KGR) per week was 7.1%. Twenty-four patients underwent subsequent hepatectomy, and two patients presented with PHLF. Twenty-nine patients (54.7%) did not undergo subsequent hepatectomy as planned due to advanced disease with 21 (72.4%) because of locally advanced cancer, peritoneal carcinomatosis, and N2 lymph nodes metastasis), four (13.8%) that refused surgical treatment, and three (10.3%) that were loss to follow-up. Conclusion: Preoperative PVE before major hepatic resection in biliary neoplasm patients is an effective procedure to increase FLR, FLR/TFLV ratio, and provide good KGR. However, more than half of post preoperative PVE could not be obtained hepatectomy because of the progression to advanced stage of disease. Keywords: Biliary neoplasm, Portal vein embolization, Future liver remnant, Major hepatic resection, Post hepatectomy liver failure

scholarly journals Preoperative Portal Vein Embolization in Hepatic Surgery: A Review about the Embolic Materials and Their Effects on Liver Regeneration and Outcome

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Jose Hugo M. Luz ◽  
Filipe V. Gomes ◽  
Elia Coimbra ◽  
Nuno V. Costa ◽  
Tiago Bilhim
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Controlled Trial ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Embolic Agent ◽  
Cyanoacrylate Glue ◽  
Liver Remnant ◽  
Ethylene Vinyl Alcohol ◽  
Embolic Materials

Liver volume and function after hepatectomies are directly correlated to postoperative complications and mortality. Consequently contemporary liver surgery has focused on reaching an adequate future liver remnant so as to diminish postoperative morbidity and mortality. Portal vein embolization has evolved and is the standard of care as a liver regenerative strategy in many surgery departments worldwide before major liver resections. Different embolic materials have been used for portal vein embolization including gelfoam, ethanol, polyvinyl-alcohol particles, calibrated microspheres, central vascular plugs, coils, n-butyl-cyanoacrylate glue, fibrin glue, polidocanol-foam, alcoholic prolamin solution, and ethylene vinyl alcohol copolymer, as sole occluders or in varied combinations. While to date there has been no prospective controlled trial comparing the efficacy of different embolic materials in portal vein embolization, retrospective data insinuates that the use of n-butyl-cyanoacrylate and absolute ethanol produces higher contralateral liver hypertrophies. In this review, we evaluated publications up to August 2019 to assess the technical and regenerative results of portal vein embolization accomplished with different embolic materials. Special attention was given to specific aspects, advantages, and drawbacks of each embolic agent used for portal vein embolization, its liver regenerative performance, and its influence on patient outcome.

scholarly journals Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

2020 ◽  
Vol 27 (7) ◽  
pp. 2311-2318 ◽  
Author(s):  
Pim B. Olthof ◽  
◽  
Luca Aldrighetti ◽  
Ruslan Alikhanov ◽  
Matteo Cescon ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Liver Failure ◽  
Portal Vein Embolization ◽  
Future Liver Remnant ◽  
International Study ◽  
Perihilar Cholangiocarcinoma ◽  
Major Liver Resection ◽  
Biliary Leakage ◽  
Liver Remnant

Abstract Background Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p < 0.001 and p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p < 0.001), as was biliary leakage (10% vs. 35%, p < 0.01), intra-abdominal abscesses (19% vs. 34%, p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.

scholarly journals Efficacy of percutaneous transhepatic portal vein embolization using gelatin sponge particles and metal coils

2018 ◽  
Vol 7 (4) ◽  
pp. 205846011876968 ◽  
Author(s):  
Tomohiro Komada ◽  
Kojiro Suzuki ◽  
Takashi Mizuno ◽  
Tomoki Ebata ◽  
Masaya Matsushima ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Clinical Status ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Gelatin Sponge ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Gelatin Sponge Particles ◽  
The Mean

Background Percutaneous transhepatic portal vein embolization (PTPE) can increase the future liver remnant (FLR) volume before extended liver resection; however, there is no current consensus regarding the best embolic material for PTPE. Purpose To evaluate the efficacy of PTPE using gelatin sponge particles and coils. Material and Methods The medical records of 136 patients who underwent PTPE using gelatin sponge particles and metal coils were retrospectively reviewed. We evaluated the procedural details, liver volume on CT, and clinical status before and after PTPE. Results The mean FLR volume increased significantly from 390 ± 147 cm3 to 508 ± 141 cm3 ( P < 0.001). A mean of 22.1 ± 9.4 days after PTPE, the mean increase in the ratio of FLR volume to total liver volume was 9.4 ± 6.5%. Complications related to PTPE occurred in five patients, including arterial damage (n = 4) and biloma (n = 1). The white blood cell count and C-reactive protein level increased significantly and then returned to baseline within seven days. Aspartate aminotransferase and alanine aminotransferase showed no significant changes. Fever (defined by the Common Terminology Criteria for Adverse Events v4.0) was reported in 74 patients (54%), but it was generally mild (Grade 1/2; n = 72). None of the patients experienced severe complications that required cancellation of surgery. Conclusion PTPE with gelatin sponge particles and coils may impose low physical stress on patients and is a safe method of inducing a significant increase of FLR.

scholarly journals Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization—the effect of collaterals on embolized liver volume

2016 ◽  
Vol 89 (1068) ◽  
pp. 20160306 ◽  
Author(s):  
Martin Zeile ◽  
Artur Bakal ◽  
Jan E Volkmer ◽  
Gregor A Stavrou ◽  
Philip Dautel ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
The Future

Portal Vein Embolization: Correlation of Future Liver Remnant Hypertrophy to Type of Embolic Agent Used

2018 ◽  
Vol 69 (3) ◽  
pp. 316-321 ◽  
Author(s):  
Surinder K. Dhaliwal ◽  
Ganesan Annamalai ◽  
Nelofer Gafoor ◽  
Robyn Pugash ◽  
Chris Dey ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Embolic Agent ◽  
Electronic Patient Records ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Radiology Reports ◽  
Pva Particles

Purpose The purpose of this study was to compare the effectiveness of portal vein embolization (PVE) with different embolic agents used at our centre. Specifically, the effectiveness of N-butyl cyanoacrylate (NBCA) glue is compared with that of polyvinyl alcohol (PVA) particles. Methods We performed a retrospective chart review of all patients (N = 77) who underwent PVE at our institution over a 5-year period. Pre- and postprocedural computed tomography or magnetic resonance imaging, when available, were used to measure the volume of total liver volume and future liver remnant (FLR). The absolute values obtained were used to calculate percentage of FLR. The growth in FLR was determined 4–6 weeks after PVE. Technical details of the procedure including the type and amount of embolic agent used were obtained from the chart reviews, electronic patient records, and radiology reports. Statistical analysis was performed using Kruskal-Wallis test, Wilcoxon rank sum test, and the Spearman correlation coefficient with post hoc analysis. Results are expressed as mean ± SD ( P < .05 considered statistically significant). Results NBCA (n = 29) produced a mean change in FLR of 14.8% compared with 9.3% for PVA particles (n = 24; P = .007). Mean change in FLR was 10.1% in the group where a combination of NBCA and PVA particles was used (n = 24). The effect of glue volume and glue-to-lipiodol ratio on the outcome was not found to be statistically significant ( P = .5 and .7, respectively). Conclusions We conclude that NBCA glue is a better embolic agent than PVA particles in inducing liver hypertrophy.

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).

Safety and efficacy of right portal vein embolization in patients with prior left lateral liver resection

2021 ◽  
pp. 028418512110141
Author(s):  
Vincent Van den Bosch ◽  
Federico Pedersoli ◽  
Sebastian Keil ◽  
Ulf P Neumann ◽  
Christiane K Kuhl ◽  
...  
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Liver Function Tests ◽  
Complete Resection ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Function Tests ◽  
Staged Hepatectomy

Background In patients with bilobar metastatic liver disease, surgical clearance of both liver lobes may be achieved through multiple-stage liver resections. For patients with extensive disease, a major two-staged hepatectomy consisting of resection of liver segments II and III before right-sided portal vein embolization (PVE) and resection of segments V–VIII may be performed, leaving only segments IV ± I as the liver remnant. Purpose To describe the outcome following right-sided PVE after prior complete resection of liver segments II and III. Material and Methods In this retrospective study, 15 patients (mean age = 60.4 ± 9.3 years) with liver metastases from colorectal cancer (n = 14) and uveal melanoma (n = 1) who were scheduled to undergo a major two-stage hepatectomy, were included. Total liver volume (TLV) and volume of the future liver remnant (FLR) were measured on pre- and postinterventional computed tomography (CT) scans, and standardized FLR volumes (ratio FLR/TLV) were calculated. Patient data were retrospectively analyzed regarding peri- and postinterventional complications, with special emphasis on liver function tests. Results The mean standardized post-PVE FLR volume was 26.9% ± 6.4% and no patient developed hepatic insufficiency after the PVE. Based on FLR hypertrophy and liver function tests, all but one patient were considered eligible for the subsequent right-sided hepatectomy. However, due to local tumor progression, only 9/15 patients eventually proceeded to the second stage of surgery.   Conclusion Right-sided PVE was safe and efficacious in this cohort of patients who had previously undergone a complete resection of liver segments II and III as part of a major staged hepatectomy pathway leaving only segments IV(±I) as the FLR. 

scholarly journals Volume Change and Liver Parenchymal Signal Intensity in Gd-EOB-DTPA-Enhanced Magnetic Resonance Imaging after Portal Vein Embolization prior to Hepatectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Ayako Akiba ◽  
Satoru Murata ◽  
Takahiko Mine ◽  
Shiro Onozawa ◽  
Tetsuro Sekine ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Portal Vein ◽  
Volume Change ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Resonance Imaging ◽  
Ct Volumetry ◽  
Liver Remnant ◽  
Enhanced Mri

Purpose.To investigate the liver volume change and the potential of early evaluation by contrast-enhanced magnetic resonance imaging (MRI) using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) after portal vein embolization (PVE).Materials and Methods.Retrospective evaluations of computed tomography (CT) volumetry of total liver and nonembolized areas were performed before and 3 weeks after PVE in 37 cases. The percentage of future liver remnant (%FLR) and the change ratio of %FLR (%FLR ratio) were calculated. Prospective evaluation of signal intensities (SIs) was performed to estimate the role of Gd-EOB-DTPA-enhanced MRI as a predictor of hypertrophy in 16 cases. The SI contrast between embolized and nonembolized areas was calculated 1 week after PVE. The change in SI contrast before and after PVE (SI ratio) was also calculated in 11 cases.Results.%FLR ratio significantly increased, and SI ratio significantly decreased (bothP<0.01). There were significant negative correlations between %FLR and SI contrast and between %FLR and SI ratio (bothP<0.01).Conclusion.Hypertrophy in the nonembolized area after PVE was indicated by CT volumetry, and measurement of SI contrast and SI ratio in Gd-EOB-DTPA-enhanced MRI early after PVE may be useful to predict the potential for hepatic hypertrophy.

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