Application of preoperative portal vein embolization before major hepatic resection in patients with normal or abnormal liver parenchyma

Wakabayashi, Hisao; Ishimura, Kimihiko; Okano, Keiichi; Karasawa, Yukihiko; Goda, Fuminori; Mizutani, Takashi; Maeta, Hajime

doi:10.1067/msy.2002.118259

Cited by 85 publications

(74 citation statements)

References 18 publications

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“…CT volumetry can be used to calculate the volume of the future remnant liver (8) and is widely used to exclude patients from liver resection or to select patients who will benefit from a procedure to increase the volume of the future remnant, such as portal vein embolization (9). However, the function of the future remnant is decreased in patients with parenchymal disease, despite a future-remnant volume that is equal to that in patients with healthy livers (7,10,11). Therefore, one can argue that determining the functional capacity of the future remnant is more important than determining the volume, especially in patients with parenchymal disease.…”

mentioning

confidence: 82%

Risk Assessment of Posthepatectomy Liver Failure Using Hepatobiliary Scintigraphy and CT Volumetry

Dinant

Graaf²,

Verwer³

et al. 2007

Journal of Nuclear Medicine

148

119

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A major part of morbidity and mortality after liver resections is caused by inadequate remnant liver function leading to liver failure. It is therefore important to develop accurate diagnostic tools that can predict the risk of liver resection-related morbidity and mortality. In this study, preoperative hepatobiliary scintigraphy of the future remnant liver and CT volumetric measurement of the future remnant liver were performed on patients who were to undergo liver resection. The accuracy of risk assessment for postoperative morbidity, liver failure, and mortality was evaluated. Methods: Forty-six patients who were scheduled for liver resection because of hepatobiliary tumors, including 17 patients with parenchymal disease (37%) and 13 patients with hilar cholangiocarcinoma (28%), were assessed preoperatively. Hepatobiliary scintigraphy was performed by drawing regions of interest around the future remnant to calculate 99m Tc-mebrofenin uptake in it. CT volumetry was used to measure the volume of the total liver, the tumors, and the future remnant. Receiver-operatingcharacteristic analysis was performed to assess cutoff values for risk assessment of morbidity, liver failure, and mortality. Furthermore, univariate and multivariate analyses were performed to determine factors related to morbidity and mortality. Results: Morbidity and mortality rates were 61% and 11%, respectively. Liver failure occurred in 6 patients (13%). Significantly decreased uptake in the future remnant was found in patients in whom liver failure and liver failure-related mortality developed (P 5 0.003 and 0.02, respectively). The volume of the future remnant was not significantly associated with any of the outcome parameters. In receiver-operating-characteristic analysis, uptake cutoff values for liver failure and liver failure-related mortality were 2.5%/min/ body surface area and 2.2%/min/body surface area, respectively. In multivariate analysis, uptake was the only significant factor associated with liver failure. Conclusion: Preoperative measurement of 99m Tc-mebrofenin uptake in the future remnant liver on hepatobiliary scintigraphy proved more valuable than measurement of the volume of the future remnant on CT in assessing the risk of liver failure and liver failure-related mortality after partial liver resection.

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mentioning

confidence: 82%

Risk Assessment of Posthepatectomy Liver Failure Using Hepatobiliary Scintigraphy and CT Volumetry

Dinant

Graaf²,

Verwer³

et al. 2007

Journal of Nuclear Medicine

148

119

View full text Add to dashboard Cite

show abstract

“…Methods of measurement of the future remnant vary, 7 but most investigators propose that preoperative PVE is indicated when the measured future liver remnant volume is expected to be less than 25% to 45% of the preoperative functional liver volume (FLV) [8][9][10][11][12] or when the standardized FLV will be less than 1% of the patient's body weight (BW). 13 Recognition that these criteria have been determined empirically 7 and that the benefits of PVE may not be as obvious for patients with normal underlying liver as for patients with chronic liver disease 14,15 has led to increased interest in better definition of the indications for PVE and clearer determination of the limits of safe resection in patients with normal liver.…”

mentioning

confidence: 99%

The small remnant liver after major liver resection: How common and how relevant?

Yigitler¹

2003

Liver Transplantation

159

111

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The maximum extent of hepatic resection compatible with a safe postoperative outcome is unknown. The study goal was to determine the incidence and impact of a small remnant liver volume after major liver resection in patients with normal liver parenchyma. Among 265 major hepatectomies performed at our institution (1998 to 2000), 138 patients with normal liver and a remnant liver volume (RLV) systematically calculated from the ratio of RLV to functional liver volume (FLV) were studied. Patients were divided into five groups based on RLV-FLV ratio from <30% to >60%. Kinetics of postoperative liver function tests were correlated with RLV. Postoperative complications were stratified by RLV-FLV ratios. Ninety patients (65%) underwent resection of up to four Couinaud segments. The RLV-FLV ratio was <60% in 94 patients (68%) including only 13 (9%) with RLV-FLV <30%. There was no linear correlation between the number of resected segments and the RLV-FLV. Postoperative serum bilirubin but not prothrombin time correlated with extent of resection. The incidence of complications including liver failure was not different among groups. Analysis of the four groups with a RLV-FLV ratio <60% showed a trend toward more complications and a longer intensive care unit stay in patients with the smallest RLVs. After major hepatectomy in patients with normal livers, the proportion of patients with a small remnant liver is low and not directly related to the number of segments resected. Although the rate of postoperative complications, including liver failure, did not directly correlate with the volume of remaining liver, the postoperative course was more difficult for patients with smaller remnants. Therefore preoperative portal vein embolization should be considered in patients who will undergo extended liver resection who have (1) injured liver or (2) normal liver when the planned procedure will be complex or when the anticipated RLV-FLV will be <30%. (Liver Transpl 2003;9:S18-S25.)

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“…A few animal studies showed that PVE using permanent embolic substances is more effective than PVE using temporary substances (9,10). Although PVE has been performed using gelfoam and coils (11)(12)(13), few reports exist regarding the comparison of the effectiveness of gelfoam alone and a gelfoamcoil combination in PVE. Therefore, the purpose of this study was to compare the effectiveness of PVE performed using gelfoam alone and a gelfoam-coil combination in patients with HCC.…”

Section: Measurement Of Liver Volumementioning

confidence: 99%

Comparison of the Effectiveness of Preoperative Portal Vein Embolization in Patients with Chronic Liver Disease: Gelfoam versus Gelfoam-Coil Combination

Shin

Chang

Choo

et al. 2015

J Korean Soc Radiol

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Application of preoperative portal vein embolization before major hepatic resection in patients with normal or abnormal liver parenchyma

Cited by 85 publications

References 18 publications

Risk Assessment of Posthepatectomy Liver Failure Using Hepatobiliary Scintigraphy and CT Volumetry

Risk Assessment of Posthepatectomy Liver Failure Using Hepatobiliary Scintigraphy and CT Volumetry

The small remnant liver after major liver resection: How common and how relevant?

Comparison of the Effectiveness of Preoperative Portal Vein Embolization in Patients with Chronic Liver Disease: Gelfoam versus Gelfoam-Coil Combination

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