Simultaneous portal and hepatic vein embolization before major liver resection
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REVIEW ARTICLE
Simultaneous portal and hepatic vein embolization before major liver resection Jan Heil 1,2 & Erik Schadde 1,3,4 Received: 3 August 2020 / Accepted: 6 August 2020 # The Author(s) 2020
Abstract Background Regenerative liver surgery expands the limitations of technical resectability by increasing the future liver remnant (FLR) volume before extended resections in order to avoid posthepatectomy liver failure (PHLF). Portal vein rerouting with ligation of one branch of the portal vein bifurcation (PVL) or embolization (PVE) leads to a moderate liver volume increase over several weeks with a clinical dropout rate of 20–40%, mostly due to tumor progression during the waiting period. Accelerated liver regeneration by the Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) was poised to overcome this limitation by reduction of the waiting time, but failed due increased perioperative complications. Simultaneous portal and hepatic vein embolization (PVE/HVE) is a novel minimal invasive way to induce rapid liver growth without the need of two surgeries. Purpose This article summarizes published results of PVE/HVE and analyzes what is known about its efficacy to achieve resection, safety, and the volume changes induced. Conclusions PVE/HVE holds promise to induce accelerated liver regeneration in a similar safety profile to PVE. The demonstrated accelerated hypertrophy may increase resectability. Randomized trials will have to compare PVE/HVE and PVE to determine if PVE/ HVE is superior to PVE. Keywords Liver . Hypertrophy . Future liver remnant . Liver regeneration . Portal vein embolization
Abbreviations 99m Tc-mebrofenin HBS ALPPS
AVP cc
Technetium-99 m hepatobiliary scintigraphy Associating liver partition and portal vein ligation for staged hepatectomy Amplatzer vascular plug Cubic centimeter
CRLM CT DH eLVD FLR HVE HQPVE IHCC ISGLS
* Erik Schadde [email protected] 1
Institute of Physiology, University of Zurich, Winterthurerstr. 190, CH-8057 Zurich, Switzerland
2
Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
3
Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
4
Department of Surgery, Rush University Medical Center Chicago, Chicago, IL, USA
KGR LVD NBCA/lipiodol NET PHCC PHLF PVE PVL RCT
Colorectal liver metastasis Computed tomography Degree of hypertrophy extended liver venous deprivation Future liver remnant Hepatic vein embolization High-quality portal vein embolization Intrahepatic cholonagiocarcinoma International Study Group of Liver Surgery Kinetic growth rate Liver venous deprivation N-Butyl-cyanoacrylate and iodized oil Neuroendocrine tumor Perihilar cholangiocarcinoma Posthepatectomy liver failure Portal vein embolization Portal vein ligation Randomized controlled trial
Langenbecks Arch Surg
SD sFLR TSH
Standard deviation standardized future liver remnant Two-staged hepatectomy
Introduction Regenerative liver surgery encompasses meth
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