Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome

Ribero, Dario; Abdalla, Eddie K.; Madoff, David C.; Donadon, Matteo; Loyer, Evelyne M.; Vauthey, Jean Nicolas

doi:10.1002/bjs.5836

Cited by 435 publications

(347 citation statements)

References 42 publications

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“…In 2004, Dindo et al proposed a modification that included a new five-grade classification system with the possibility of combining grades; ''disability'' was added to the system, ''hospital stay'' was eliminated as a complication and ''organ failure'' was changed to carry more weight in grading [12]. The so-called ''Clavien-Dindo'' classification has been adapted for use in general surgery [10] and for other surgical subspecialties such as gastroenterology/hepatology [3,11,17,[22][23][24][25]28], urology [19], and nephrology [18,27]. Given this system appears useful for general surgery and other specialties, we explored its use in orthopaedic surgery.…”

Section: Introductionmentioning

confidence: 99%

Reliability of a Complication Classification System for Orthopaedic Surgery

Sink

Leunig

Zaltz³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

265

176

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Background Quality of health care and safety have been emphasized by various professional and governmental groups. However, no standardized method exists for grading and reporting complications in orthopaedic surgery. Conclusions regarding outcomes are incomplete without a standardized, objective complication grading scheme applied concurrently. The general surgery literature has the Clavien-Dindo classification that meets the above criteria.Questions/purposes We asked whether a previously reported classification would show high intraobserver and interobserver reliabilities when modified for orthopaedic surgery specifically looking at hip preservation surgery. We therefore determined the interreader and intrareader reliabilities of the adapted classification scheme as applied to hip preservation surgery. Methods We adapted the validated Clavien-Dindo complication classification system and tested its reliability for orthopaedic surgery, specifically hip preservation surgery. There are five grades based on the treatment required to manage the complication and the potential for long-term morbidity. Forty-four complication scenarios were created from a prospective multicenter database of hip preservation procedures and from the literature. Ten readers who perform hip surgery at eight centers in three countries graded the scenarios at two different times. Fleiss' and Cohen's j statistics were performed for interobserver and intraobserver reliabilities, respectively. Results The overall Fleiss' j value for interobserver reliability was 0.887 (95% CI, 0.855-0.891). The weighted j was 0.925 (95% CI, 0.894-0.956) for Grade I, 0.838 (95% CI, 0.807-0.869) for Grade II, 0.87 (95% CI, 0.835-0.866) for Grade III, and 0.898 (95% CI, 0.866-0.929) for

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Section: Introductionmentioning

confidence: 99%

Reliability of a Complication Classification System for Orthopaedic Surgery

Sink

Leunig

Zaltz³

et al. 2012

Clinical Orthopaedics &Amp; Related Research

265

176

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“…[10,[28][29][30] Liver volume assessed 3-4 weeks post portal vein embolisation shows an increase in volume of 5% being associated with improved patient outcomes. [8] Lewis et al 2006 [10] found liver volume reduced by 14% over a six week period following the implementation of a low calorie diet. Edholm et al 2014 [28] showed an average decrease in liver size of 18% in ten female participants following two weeks on a low calorie diet.…”

Section: Discussionmentioning

confidence: 99%

“…An increase in size of 5% is associated with improved patient outcomes. [8] In addition to this, liver volume calculations are commonly used to estimate drainage volume prior to endoscopic biliary drainage. [9] Liver volume is also commonly assessed six weeks and one week prior to gastric banding surgery to ensure adequate volume reduction.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography volume measurements of the liver using a liver segmentation and analysis package: an intra- and inter-rater reliability study

Childs

Thoirs

Esterman

2015

JBGC

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Introduction: Recent advances in technology have seen the introduction of software assisted image post-processing (SAIP) tools to calculate the volume of the liver from Computed Tomography (CT) images. One such SAIP tool is the semi-automated Philips liver segmentation and analysis package (Endhoven, The Netherlands). The intra-and inter-rater reliability of the liver volumes of 16 participants calculated using this tool was assessed. Methods: Two CT Technologists accessed Abdominal CT data sets and calculated the volume of the liver using the Philips liver segmentation and analysis package. One technologist repeated their calculation. Results: Results demonstrated high intra-rater reliability (ICC 0.9997) and high inter-rater reliability (ICC 0.99994). Analysis with Bland Altman plots showed the mean bias for both intra-and inter-rater reliability to be close to zero with acceptable limits of agreement. Conclusions: This study has shown that liver volume measurements using the Philips SAIP (Endhoven, The Netherlands) can be taken reliably by CT technologists, with confidence that the same results would be obtained between different CT technologists.

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“…As such, an absolute percentage point increase of >5 % is associated with significant reduction in the risk of PHI and death. 23 Frequently, patients with extensive liver disease require two-stage hepatectomy. Combined with perioperative chemotherapy, two-stage hepatectomy +/− PVE can result in prolonged 5-year OS of 51 %.…”

Section: Metachronous Presentation Of Extensive (Multifocal and Bilatmentioning

confidence: 99%

Colorectal Liver Metastases

Tzeng

Aloia

2013

Journal of Gastrointestinal Surgery

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Background With modern multimodality therapy, patients with resected colorectal cancer (CRC) liver metastases (CLM) can experience up to 50-60 % 5-year survival. These improved outcomes have become more commonplace via achievements in multidisciplinary care, improved definition of resectability, and advances in technical skill. Discussion Even patients with synchronous and/or extensive bilateral disease have benefited from novel surgical strategies. Treatment sequencing of synchronous CRC with CLM can be simplified into the following three paradigms: (classic colorectalfirst), simultaneous (combined), or reverse approach (liver-first). The decision of whether to treat the CLM or CRC first depends on which site dominates oncologically and symptomatically. Oxaliplatin with 5-fluorouracil/leucovorin (FOLFOX) and irinotecan with 5-fluorouracil/leucovorin (FOLFIRI) are the foundations of modern chemotherapy. Although each regimen has positively impacted survivals, both have the potential for negative effects on the non-tumor liver. Oxaliplatin is associated with vascular injury (sinusoidal ballooning, microvascular injury, nodular regenerative hyperplasia, and long-term fibrosis) but not steatosis. Irinotecan has been associated with steatohepatitis, especially in patients with obesity and diabetes. Steatohepatitis from irinotecan is the only chemotherapy-associated liver injury (CALI) associated with increased mortality from postoperative hepatic insufficiency. Extended duration of preoperative chemotherapy is also associated with CALI. Conclusions To determine resectability and to prevent overtreatment with systemic therapy, all patients should receive highquality cross-sectional imaging and be evaluated by a hepatobiliary surgeon before starting chemotherapy. Even as chemotherapy improves, liver surgeons will continue to play a central role in treatment planning by offering the best chance for prolonged survival-safe R0 resection with curative intent.

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Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome

Abstract: DH contributes prognostic information additional to that gained by volumetric evaluation in patients undergoing PVE.

Cited by 435 publications

References 42 publications

Reliability of a Complication Classification System for Orthopaedic Surgery

Reliability of a Complication Classification System for Orthopaedic Surgery

Computed tomography volume measurements of the liver using a liver segmentation and analysis package: an intra- and inter-rater reliability study

Colorectal Liver Metastases

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