Hybrid transileocecal portal vein embolization associated with staging laparoscopy for planned major hepatectomy in adva
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ORIGINAL ARTICLE
Hybrid transileocecal portal vein embolization associated with staging laparoscopy for planned major hepatectomy in advanced hepatobiliary cancers Yasunari Kawabata 1 & Hikota Hayashi 1 & Rika Yoshida 2 & Shinji Ando 2 & Kosuke Nakamura 1 & Takeshi Nishi 1 & Megumi Nakamura 2 & Yoshitsugu Tajima 1 Received: 23 September 2020 / Accepted: 15 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Portal vein embolization (PVE) is widely used to promote the hypertrophy of a future liver remnant (FLR) and reduce posthepatectomy liver failure. The aim of this study was to evaluate the efficacy of transileocecal portal embolization (TIPE) associated with staging laparoscopy (hybrid lap-TIPE) for a planned hepatectomy in advanced hepatobiliary cancers. Methods The hybrid lap-TIPE procedure consisted of staging laparoscopy for complete screening of the abdominal cavity with cytoreductive surgery and subsequent TIPE. Data on hybrid lap-TIPE, performed between March 2013 and February 2020, were collected retrospectively. Results Hybrid lap-TIPE was conducted for 52 patients, and a subsequent TIPE was accomplished in 42 patients (80.8%), since staging laparoscopy detected latent or unresectable factors in 13 patients (25.0%), among which 2 patients with hepatocellular carcinoma and 1 with colorectal liver metastasis received laparoscopic cytoreductive surgery for latent lesions in the FLR. Finally, radical hepatectomy was completed in 36 patients (69.2%), including 3 patients who underwent cytoreductive surgery. The most common operation was an extended right hepatectomy (50.0%), followed by right hepatectomy (30.6%), including 3 hepatopancreatoduodenectomies. The overall morbidity associated with hybrid lap-TIPE and hepatectomy was 7.1% and 41.7%, respectively. The mortality associated with hybrid lap-TIPE and hepatectomy was 0% and 5.6%, respectively. The rates of 2-year survival and 2-year disease-free survival were 64.8% and 61.9%, respectively, after hepatectomy. Conclusions Hybrid lap-TIPE is safe and could be a useful treatment option for patients with advanced hepatobiliary cancer because it can help to identify optimal candidates for PVE followed by a planned hepatectomy. Keywords Hepatobiliary cancer . Staging laparoscopy . Portal vein embolization . Ileocecal vein . Planned hepatectomy
Introduction Complete tumor resection remains the gold standard treatment for patients with either primary or secondary hepatobiliary cancer, and it offers a chance for long-term survival. Extended liver resection is often required to achieve clear
* Yasunari Kawabata [email protected] 1
Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan
2
Department of Radiology, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan
resection margins in advanced hepatobiliary cancers; however, insufficient volume or function of the future liver remnant (FLR) could be
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