Feasibility of laparoscopic portal vein ligation prior to major hepatectomy

Are, Chandrakanth; Iacovitti, S.; Prete, F.; Crafa, Francesco

doi:10.1080/13651820802175261

Cited by 31 publications

(13 citation statements)

References 22 publications

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“…Percutaneous PVE obviously is a less invasive procedure than PVL requiring a laparotomy. However, reports are accumulating in which PVL is undertaken laparoscopically, hence combining a staging procedure with PVL in one minimally invasive session [11]. …”

Section: What Is the Most Effective Technique: Portal Vein Ligation Omentioning

confidence: 99%

Controversies in the Use of Portal Vein Embolization

Gulik

Esschert²,

Graaf³

et al. 2008

Dig Surg

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Background/Aims: Portal vein embolization (PVE) has reached worldwide acceptance to increase future remnant liver (FRL) volume before undertaking major liver resection. The aim of this overview is to point out and discuss current controversies in the application of PVE. Methods: Review of literature pertaining to techniques of PVE, complications, tumor proliferation, timing of resection, and hypertrophy response after PVE. Results: Procedure-related complications after PVE include hematoma, hemobilia, overflow of embolization material, and thrombosis of portal vein branch(es) of the non-embolized lobe. Persistence of the embolized, atrophic lobe is usually not harmful. Embolization of the portal branches to segment 4 in addition to embolization of the right portal trunk is controversial and is advised only in selected cases. It remains undecided whether embolization of the portal venous system is more effective in inducing hypertrophy of the FRL than ligation of the portal vein. Accelerated tumor growth after PVE is a major concern and requires consideration of post-PVE chemotherapy. A waiting time of 3 weeks between PVE and liver resection is advised. Post-hepatectomy regeneration is not hampered after preoperative PVE. Conclusion: PVE is a useful preoperative intervention to increase volume and function of the FRL. Further progress awaits clarification of the mechanisms of the hypertrophy response induced by PVE in conjunction with new embolization materials and protective chemotherapy.

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Section: What Is the Most Effective Technique: Portal Vein Ligation Omentioning

confidence: 99%

Controversies in the Use of Portal Vein Embolization

Gulik

Esschert²,

Graaf³

et al. 2008

Dig Surg

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“…Several techniques for portal vein occlusion have been reported, including intraoperative portal branch ligation [8–10], transileocolic PVE [11–13], and the percutaneous transhepatic ipsilateral [14, 15] or contralateral [16, 17] PVE technique. The underlying principle is to block the portal venous blood flow to the liver segments that are planned to be resected.…”

Section: Introductionmentioning

confidence: 99%

Portal Vein Embolization Before Liver Resection: A Systematic Review

Lienden

Esschert

Graaf

et al. 2012

Cardiovasc Intervent Radiol

381

337

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PurposeThis is a review of literature on the indications, technique, and outcome of portal vein embolization (PVE).MethodsA systematic literature search on outcome of PVE from 1990 to 2011 was performed in Medline, Cochrane, and Embase databases.ResultsForty-four articles were selected, including 1,791 patients with a mean age of 61 ± 4.1 years. Overall technical success rate was 99.3 %. The mean hypertrophy rate of the FRL after PVE was 37.9 ± 0.1 %. In 70 patients (3.9 %), surgery was not performed because of failure of PVE (clinical success rate 96.1 %). In 51 patients (2.8 %), the hypertrophy response was insufficient to perform liver resection. In the other 17 cases, 12 did not technically succeed (0.7 %) and 7 caused a complication leading to unresectability (0.4 %). In 6.1 %, resection was cancelled because of local tumor progression after PVE. Major complications were seen in 2.5 %, and the mortality rate was 0.1 %. A head-to-head comparison shows a negative effect of liver cirrhosis on hypertrophy response. The use of n-butyl cyanoacrylate seems to have a greater effect on hypertrophy, but the difference with other embolization materials did not reach statistical significance. No difference in regeneration is seen in patients with cholestasis or chemotherapy.ConclusionsPreoperative PVE has a high technical and clinical success rate. Liver cirrhosis has a negative effect on regeneration, but cholestasis and chemotherapy do not seem to have an influence on the hypertrophy response. The use of n-butyl cyanoacrylate may result in a greater hypertrophy response compared with other embolization materials used.

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“…Consequently, in recent literature, a residual volume, the "standardized FLR" (sFLR) of 25-30% has been described as the benchmark in patients with normal liver function 7 and volumes of at least 40% in patients with parenchymal liver disease. 8,9 Three methods to enlarge FLR are possible in this situation before ERH: (1) surgical right-sided portal vein ligation (PVL), 10,11 (2) portal vein embolization (PVE) as an interventional approach used by various centres [12][13][14] and (3) the surgical approach of "associating liver partition with PVL for staged hepatectomy". [15][16][17] However, as hypertrophy following PVE is necessary but highly variable, we retrospectively analyzed data from our patient cohort for differences in those with good hypertrophy (increase to .25% of the sFLR) and those with a less beneficial increase in size of sFLR.…”

Section: Introductionmentioning

confidence: 99%

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

Zeile¹,

Bakal

Volkmer³

et al. 2016

The British Journal of Radiology

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Objective: The purpose of this retrospective study was to monitor hypertrophy of future liver remnant following portal vein embolization (PVE) before planned extended right hepatectomy. However, because individual responses to PVE are highly variable, our focus was to identify cofactors of successful hypertrophy. Methods: 28 patients with primary or secondary liver tumours, mean age 64.1 6 12.9 years, underwent PVE. Volumetric analysis of hypertrophy before and after PVE (median 39.0 6 15.7 days) was performed. The embolized liver segments were investigated for occurrence of reperfusion of their portal branches. Blood parameters before PVE were additionally investigated. Results: Patients were divided into responders (21/28) and non-responders (7/28) by post-PVE standardized future liver remnant being above or below 25%, respectively. No significant differences between the groups were found regarding biometric and volumetric parameters before PVE. In the entire group after PVE, the mean absolute increase of Segments 2 and 3 was 196.0 6 84.7 cm 3 and the median relative increase was 46.6 6 98.8%. The formation of left to right hepatic portoportal collaterals exhibited a negative correlation to successful hypertrophy (p 5 0.004) as well as low plasma total protein (p 5 0.019). Successful embolization of Segment IV showed only a trend to significance (p 5 0.098). Conclusion: Cofactors associated with a favourable outcome regarding hypertrophy were the absence of collaterals in the control CT scans and high plasma total protein. Advances in knowledge:Portoportal collaterals negatively influence hypertrophy after PVE. On the other hand, plasma total protein is a positive prognostic indicator on hypertrophy of the liver in our cohort.

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Feasibility of laparoscopic portal vein ligation prior to major hepatectomy

Abstract: LPVL is feasible and can be safely performed. In a select group of patients, it may be considered as an alternative to subsequent embolization and thereby potentially absolve the need for an additional procedure with its attendant complications.

Cited by 31 publications

References 22 publications

Controversies in the Use of Portal Vein Embolization

Controversies in the Use of Portal Vein Embolization

Portal Vein Embolization Before Liver Resection: A Systematic Review

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

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