Perioperative impact of liver venous deprivation compared with portal venous embolization in patients undergoing right hepatectomy: preliminary results from the pioneer center

Panaro, Fabrizio; Giannone, Fabio; Rivière, Benjamin; Sgarbură, Olivia; Cusumano, Caterina; Deshayes, Emmanuel; Navarro, Francis; Guiu, Boris; Quénet, François

doi:10.21037/hbsn.2019.07.06

Cited by 66 publications

(87 citation statements)

References 32 publications

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“…Extended liver venous deprivation with embolization of the right portal vein, right hepatic vein, and middle hepatic vein has also been described [ 73 ]. Comparing liver venous deprivation to PVE, single-center studies have noted that ipsilateral venous deprivation before major hepatectomy induces similar or greater/faster FLR hypertrophy than after PVE alone with similar morbidity and mortality [ 71 , 74 , 75 ]. Both PVE and liver venous deprivation can be considered when assessing patients with ICC who are in need of an extended liver resection.…”

Section: Surgical Principlesmentioning

confidence: 99%

Surgical Treatment of Intrahepatic Cholangiocarcinoma: Current and Emerging Principles

Beal

Cloyd

Pawlik

2020

JCM

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Intrahepatic cholangiocarcinoma (ICC) is a rare, aggressive cancer of the biliary tract. It often presents with locally advanced or metastatic disease, but for patients with early-stage disease, surgical resection with negative margins and portahepatis lymphadenectomy is the standard of care. Recent advancements in ICC include refinement of staging, improvement in liver-directed therapies, clarification of the role of adjuvant therapy based on new randomized controlled trials, and advances in minimally invasive liver surgery. In addition, improvements in neoadjuvant strategies and surgical techniques have enabled expanded surgical indications and reduced surgical morbidity and mortality. However, recurrence rates remain high and more effective systemic therapies are still necessary to improve recurrence-free and overall survival. In this review, we focus on current and emerging surgical principals for the management of ICC including preoperative evaluation, current indications for surgery, strategies for future liver remnant augmentation, technical principles, and the role of neoadjuvant and adjuvant therapies.

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Section: Surgical Principlesmentioning

confidence: 99%

Surgical Treatment of Intrahepatic Cholangiocarcinoma: Current and Emerging Principles

Beal

Cloyd

Pawlik

2020

JCM

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“…Furthermore, the LVD technique has been shown in our series to be feasible, well tolerated and to provide an important augmentation of the FLR volume for right hepatectomy, with acceptable morbidity and mortality. Previous data on perioperative surgical outcomes had already been reported by our group [ 19 ]. In the previous paper data from LVD and PVE before major hepatectomies were compared, but in a smaller sample of patients with any indication.…”

Section: Discussionmentioning

confidence: 96%

“…Over the past 5 years, a new radiological interventional technique of liver venous deprivation (LVD) has emerged. It consists of simultaneous embolization of portal vein and one or two hepatic veins, in order to increase the damage to the liver leading to increased hypertrophy of the contralateral parenchyma [ 16 , 17 , 18 ], with a kinetic growth rate of 16 ± 7 cc/day according to first reports [ 19 ]. Recently, first comparative data have been published regarding FLR volume and function gains [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Oncological Outcomes after Liver Venous Deprivation for Colorectal Liver Metastases: A Single Center Experience

Khayat

Cassese

Quénet

et al. 2021

Cancers

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Colorectal liver metastases (CRLM) are the major cause of death in patients with colorectal cancer (CRC). The cornerstone treatment of CRLM is surgical resection. Post-operative morbidity and mortality are mainly linked to an inadequate future liver remnant (FLR). Nowadays preoperative portal vein embolization (PVE) is the most widely performed technique to increase the size of the future liver remnant (FLR) before major hepatectomies. One method recently proposed to increase the FLR is liver venous deprivation (LVD), but its oncological impact is still unknown. The aim of this study is to report first short- and long-term oncological outcomes after LVD in patients undergoing right (or extended right) hepatectomy for CRLM. Seventeen consecutive patients undergoing LVD between July 2015 and May 2020 before an (extended) right hepatectomy were retrospectively analyzed from an institutional database. Post-operative and follow-up data were analyzed and reported. Primary outcomes were 1-year and 3-year overall survival (OS) and hepatic recurrence (HR). Postoperative complications occurred in 8 patients (47%). No deaths occurred after surgery. HR occurred in 9 patients (52.9%). 1-year and 3-year OS were 87% (95% confidence interval [CI]: ±16%) and 60.3%, respectively (95% CI: ±23%). Median Disease-Free Survival (DFS) was 6 months (CI 95%: 4.7–7.2). With all the limitations of a retrospective study with a small sample size, LVD showed similar oncological outcomes compared to literature reports for Portal Vein Embolization (PVE).

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“…Since the first publication, seven further reports including between 6 and 37 patients have been published [17,18,[23][24][25][26][27][28]. PVE/HVE was mainly used to treat CRLM (55%); however, most studies included both primary and secondary liver tumors [29].…”

Section: One-stage Hepatectomy With Portal Veinand Hepatic Vein Embolmentioning

confidence: 99%

Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation–assisted liver surgery

Müller¹,

Linecker

Kırımker

et al. 2021

Langenbecks Arch Surg

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Background Liver surgery and transplantation currently represent the only curative treatment options for primary and secondary hepatic malignancies. Despite the ability of the liver to regenerate after tissue loss, 25–30% future liver remnant is considered the minimum requirement to prevent serious risk for post-hepatectomy liver failure. Purpose The aim of this review is to depict the various interventions for liver parenchyma augmentation–assisting surgery enabling extended liver resections. The article summarizes one- and two-stage procedures with a focus on hypertrophy- and corresponding resection rates. Conclusions To induce liver parenchymal augmentation prior to hepatectomy, most techniques rely on portal vein occlusion, but more recently inclusion of parenchymal splitting, hepatic vein occlusion, and partial liver transplantation has extended the technical armamentarium. Safely accomplishing major and ultimately total hepatectomy by these techniques requires integration into a meaningful oncological concept. The advent of highly effective chemotherapeutic regimen in the neo-adjuvant, interstage, and adjuvant setting has underlined an aggressive surgical approach in the given setting to convert formerly “palliative” disease into a curative and sometimes in a “chronic” disease.

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Perioperative impact of liver venous deprivation compared with portal venous embolization in patients undergoing right hepatectomy: preliminary results from the pioneer center

Cited by 66 publications

References 32 publications

Surgical Treatment of Intrahepatic Cholangiocarcinoma: Current and Emerging Principles

Surgical Treatment of Intrahepatic Cholangiocarcinoma: Current and Emerging Principles

Oncological Outcomes after Liver Venous Deprivation for Colorectal Liver Metastases: A Single Center Experience

Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation–assisted liver surgery

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