Percutaneous Portal Vein Embolization Increases the Feasibility and Safety of Major Liver Resection for Hepatocellular Carcinoma in Injured Liver

Azoulay, Daniel; Castaing, Denis; Krissat, Jinane; Smail, Alloua; Hargreaves, Guillermo Marín; Lemoine, Antoinette; Émile, Jean-François; Bismuth, H

doi:10.1097/00000658-200011000-00008

Cited by 363 publications

(266 citation statements)

References 45 publications

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“…Previous studies addressing this issue have yielded conflicting results. [9][10][11]22 In the present study, the global incidence of complications (whether minor or major) and the duration of in-hospital stay were not significantly different in patients with the smallest or largest remnant liver volumes. However, a notable trend is recognized when the remnant volume decreases from 51% to 60% to Ͻ30%: the length of ICU stay doubles and hospital stay is nearly 50% longer in the small residual volume group.…”

Section: S22contrasting

confidence: 43%

“…11 The functional liver volumes were computed from the patients' body weights and heights using a formula 16 that proved to be very accurate in our patients. As in similar studies, tumor volumes were considered to be nonfunctional liver parenchyma, 9,[20][21][22] and patients with multiple tumors that could not be accurately measured were excluded from the analysis. 11,20 Our first objective was to determine how often a major hepatectomy results in a small RLV.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: S22contrasting

confidence: 43%

Section: Discussionmentioning

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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“…A recent meta-analysis has demonstrated that PVE is safe and effective in inducing liver hypertrophy and preventing liver failure [33] . It has also been shown to increase resectability [34,35] . It should be noted that the recurrence rate after hepatic resection is high.…”

Section: Surgical Resectionmentioning

confidence: 99%

Surgical management of hepatocellular carcinoma

Pang

Lam

2014

WJH

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Hepatocellular carcinoma (HCC) is the second most common cause of death from cancer worldwide. Standard potentially curative treatments are either resection or transplantation. The aim of this paper is to provide an overview of the surgical management of HCC, as well as highlight current issues in hepatic resection and transplantation. In summary, due to the relationship between HCC and chronic liver disease, the management of HCC depends both on tumourrelated and hepatic function-related considerations. As such, HCC is currently managed largely through nonsurgical means as the criteria, in relation to the above considerations, for surgical management is still largely

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“…Anyway, major resections are not recommended even in compensated cirrhotic patients because of the risk of post operative liver failure due to an insufficient remnant liver, which can lead to death [9] . Nevertheless and thanks to the advance in several techniques such as portal vein embolization, some groups perform major hepatectomies for HCC after portal vein embolization if there is a sufficient growth of the liver remnant [23,24] . The discussion between anatomic vs non anatomic resection still remains.…”

Section: Liver Resectionmentioning

confidence: 99%

Management of “very early” hepatocellular carcinoma on cirrhotic patients

Sevilla

Echeverri

Charco

2014

WJH

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Due to the advances in screening of cirrhotic patients, hepatocellular carcinoma (HCC) is being diagnosed in earlier stages. For this reason the number of patients diagnosed of very early HCC (single tumors ≤ 2 cm) is continuously increasing. Once a patient has been diagnosed with this condition, treatment strategies include liver resection, local therapies or liver transplantation. The decision on which therapy should the patient undergo depends on the general patients performance status and liver disease. Anyway, even in patients with similar conditions, the best treatment offer is debatable. In this review we analyze the state of the art on the management of very early HCC on cirrhotic patients to address the best treatment strategy for this patient population.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Hepatocellular carcinoma; Very early; Liver resection; Liver transplantation; Local therapiesCore tip: Very early hepatocellular carcinoma patients are deemed too early for liver transplantation candidacy, known as the best treatment regarding long-term survival and tumor recurrence. Strategies as surgical resection and radiofrequency ablation have gained popularity. Although resection is considered as the first line of treatment, recent studies claim equal results with ablation techniques. Ablation used as a test of time in patients who remain candidates for liver transplantation is attractive. In this review we will analyze in detail the novel strategy repertoire used in the management of these patients.Sapisochin G, Fernandez de Sevilla E, Echeverri J, Charco R. Management of "very early" hepatocellular carcinoma on cirrhotic patients.

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Percutaneous Portal Vein Embolization Increases the Feasibility and Safety of Major Liver Resection for Hepatocellular Carcinoma in Injured Liver

Abstract: With the use of PVE, more patients with previously unresectable HCC in injured liver can benefit from resection. Long-term survival rates are comparable to those after resection without PVE.

Cited by 363 publications

References 45 publications

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

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

Surgical management of hepatocellular carcinoma

Management of “very early” hepatocellular carcinoma on cirrhotic patients

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