A systematic review of the impact of portal vein pressure changes on clinical outcomes following hepatic resection

Gavriilidis, Paschalis; Hammond, John S.; Hidalgo, Ernest

doi:10.1016/j.hpb.2020.07.006

Cited by 10 publications

(6 citation statements)

References 34 publications

(109 reference statements)

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“…In addition, although 3 cases had a waiting period of 4 weeks and were unable to achieve our targeted resection rate of less than 60%, it was reported that the increase in volume would plateau in approximately 3 weeks (21), so it was possible to complete the surgery without complications in the 3 cases mentioned above. Some have reported that elevated PVP after hepatectomy is associated with mortality and PHLF (22,23); however there are also reports stating that elevated PVP after PVE decreases to pre-embolization level in 24 hours (24). In our cases, PVP during the hepatectomy is unknown because it was not measured.…”

Section: Discussionmentioning

confidence: 99%

Liberal Application of Portal Vein Embolization for Right Hepatectomy Against Hepatocellular Carcinoma: Strategy to Achieve Zero Mortality for a Damaged Liver

et al. 2022

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Background/Aim: Right hepatectomy and extended right hepatectomy (Rt-Hr) are identified as risk factors for the development of post-hepatectomy liver failure (PHLF). Although portal vein embolization (PVE) has made it possible to safely perform extended hepatectomy, to ensure safety, in our department, PVE is performed prior to Rt-Hr for hepatocellular carcinoma (HCC) regardless of the resection rate. This study aimed to retrospectively investigate the clinical course of PVE prior to Rt-Hr for HCC cases resected in our department and the appropriateness of our policy by clarifying complications and deaths. Patients and Methods: The target period was from 2005 to 2020. Among the HCC cases resected at our hospital, those in which PVE was performed prior to Rt-Hr were included in this study. For PHLF, the definition of the International Study Group of Liver Surgery was used. The Clavien-Dindo classification was used for postoperative complications. Perioperative mortality was defined as the overall mortality within 30 days following surgery and surgery-related deaths within 90 days following surgery. Results: A total of 79 cases were included. Rt-Hr was possible in all cases after PVE and there were no cases in which serious complications occurred after PVE. PHLF was found in 14 cases (17.7%)/5 cases (6.4%)/0 cases (0%) of Grade A/B/C, respectively. Regarding postoperative complications, there were no Grade IV, and Grade IIIa/IIIb were found in 13 cases (16.5%). There were no perioperative deaths. Conclusion: Our department's policy of performing PVE prior to all Rt-Hr was considered to be a safe and reasonable treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Liberal Application of Portal Vein Embolization for Right Hepatectomy Against Hepatocellular Carcinoma: Strategy to Achieve Zero Mortality for a Damaged Liver

et al. 2022

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“…As a common risk for all small transplant grafts, the RAPID technique also needs to resolve PV hyperperfusion, which causes arterial vascular structure damage, inhibits liver regeneration and causes graft dysfunction[ 50 ]. Based on ALPPS andhepatectomy experience, higher portal vein inflow pressure is associated with an increased incidence of morbidity and mortality.…”

Section: Advances In Lt Surgery For Crlmmentioning

confidence: 99%

Advances in liver transplantation for unresectable colon cancer liver metastasis

Chen¹,

Geng²,

Zhou³

et al. 2021

WJGS

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It is estimated that 50% of patients with colorectal cancer will develop liver metastasis. Surgical resection significantly improves survival and provides a chance of cure for patients with colorectal cancer liver metastasis (CRLM). Increasing the resectability of primary unresectable liver metastasis provides more survival benefit for those patients. Considerable surgical innovations have been made to increase the resection rate and decrease the potential risk of hepatic failure postoperation. Liver transplantation (LT) has been explored as a potential curative treatment for unresectable CRLM. However, candidate selection criteria, chemotherapy strategies, refined immunity regimens and resolution for the shortage of grafts are lacking. This manuscript discusses views on surgical indication, peritransplantation anti-tumor and anti-immunity therapy and updated advances in LT for unresectable CRLM. A literature review of published articles and registered clinical trials in PubMed, Google Scholar, and Clinicaltrials.gov was performed to identify studies related to LT for CRLM. Some research topics were identified, including indications for LT for CRLM, oncological risk, antitumor regimens, graft loss, administration of anti-immunity drugs and solutions for graft deficiency. The main candidate selection criteria are good patient performance, good tumor biological behavior and chemosensitivity. Chemotherapy should be administered before transplantation but is not commonly administered posttransplantation for preventive purposes. Mammalian target of rapamycin regimens are recommended for their potential oncological benefit, although there are limited cases. In addition to extended criterion grafts, living donor grafts and small grafts combined with two-stage hepatectomy are efficient means to resolve organ deficiency. LT has been proven to be an effective treatment for selected patients with liver-only CRLM. Due to limited donor grafts, high cost and poorly clarified oncological risks, LT for unresectable CRLM should be strictly performed under a well-organized study plan in selected patients. Some vital factors, like LT indication and anti-tumor and anti-immune treatment, remain to be confirmed. Ongoing clinical trials are expected to delineate these topics.

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“…In the late 1990s, a paradigm shift occurred with data demonstrating that these surgical approaches could achieve a complete resection with acceptable morbidity ( 9 ). In turn, multimodality treatment has increasingly focused on the prevention of postoperative liver failure secondary to an insufficient FLR complete (Ro) resection rather than tumour-related parameters such as size, number, or location ( 10 - 13 ).…”

mentioning

confidence: 99%

Associating liver partition and portal vein ligation or combined transarterial chemo-embolisation and portal vein embolisation for staged hepatectomy for HBV-related hepatocellular carcinoma

Gavriilidis¹,

Pawlik²,

Meirson³

et al. 2023

Hepatobiliary Surg Nutr

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Many patients with hepatocellular carcinoma are diagnosed with large tumours at an advanced stage. In addition, conditions such as liver fibrosis, cirrhosis, portal hypertension, viral load, and portal vein thrombosis due to either non-neoplastic or portal vein tumour thrombus limit the indications for surgical management to a select subset of individuals (1). In fact, based on the American Association for the study of the liver (AASLD) and European Association for the study of the liver (EASL) guidelines surgical management is generally limited to patients with Barcelona Clinical Liver Cancer Criteria (BCLC) stage A disease (2). However, several centres of hepatobiliary surgical centers of excellence in East Asian countries have demonstrated the potential benefit of hepatic resection for patients with BCLC stage B and C disease. In turn, based data derived from these centers, new guidelines have been proposed that push expand operability criteria (3-5).In considering the data, the principal aim of any multimodality treatment strategy should be to identify the subgroups of individuals and the specific individual patients who may benefit from surgical resection. Hepatic resection for patients with extensive disease can typically be defined into three categories: (I) single hepatic resection with or without modulation of functional liver remnant (FLR), (II) two stage or multistage hepatectomy usually with modulation of FLR and (III) parenchyma-sparing hepatic resection (6-8). In the late 1990s, a paradigm shift occurred with data demonstrating that these surgical approaches could achieve a complete resection with acceptable morbidity (9). In turn, multimodality treatment has increasingly focused on the prevention of postoperative liver failure secondary to an insufficient FLR complete (Ro) resection rather than tumour-related parameters such as size, number, or location (10-13).

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A systematic review of the impact of portal vein pressure changes on clinical outcomes following hepatic resection

Cited by 10 publications

References 34 publications

Liberal Application of Portal Vein Embolization for Right Hepatectomy Against Hepatocellular Carcinoma: Strategy to Achieve Zero Mortality for a Damaged Liver

Liberal Application of Portal Vein Embolization for Right Hepatectomy Against Hepatocellular Carcinoma: Strategy to Achieve Zero Mortality for a Damaged Liver

Advances in liver transplantation for unresectable colon cancer liver metastasis

Associating liver partition and portal vein ligation or combined transarterial chemo-embolisation and portal vein embolisation for staged hepatectomy for HBV-related hepatocellular carcinoma

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