Portal vein embolization in extended liver resection

Narula, Nisha; Aloia, Thomas A.

doi:10.1007/s00423-017-1591-8

Cited by 30 publications

(22 citation statements)

References 67 publications

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“…Portal vein embolization (PVE) is considered the goldstandard procedure to enhance the future liver remnant (FLR) before major liver resection and to reduce the risk of postoperative liver failure and mortality. 1,2 Since its introduction more than three decades ago, PVE has shown to induce an increase in FLR volume (FLRV) in both healthy and compromised liver parenchyma, while associated with minimal adverse events. [3][4][5] A decrease in postoperative liver failure using PVE has frequently been reported; however, in the only prospective comparative clinical trial, undertaken by Farges et al in 2003, PVE decreased postoperative complications only in patients with compromised liver parenchyma at increased risk of liver failure.…”

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confidence: 99%

Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

et al. 2020

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Background. Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection.Objective. This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods. Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results. A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p \ 0.001 and p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p \ 0.001), as was biliary leakage (10% vs. 35%, p \ 0.01), intra-abdominal abscesses (19% vs. 34%, p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion. PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.

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confidence: 99%

Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

et al. 2020

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“…Rex recess is defined as the space between segments 3 and 4 under the liver bridge and similarly refers to the point where the portal vein bifurcates to supply those segments [25]. Some authors advise to avoid the Rex recess puncture due to the thick and fibrotic tissue around the periportal area [26]. One immediate advantage of the contralateral access is the use of shorter catheters (e.g., 30 cm to 40 cm long), which are easier to handle and might prevent the use of an introducer and microcatheter.…”

Section: Contralateral Accessmentioning

confidence: 99%

Preoperative Portal Vein Embolization in Hepatic Surgery: A Review about the Embolic Materials and Their Effects on Liver Regeneration and Outcome

Luz

Gomes

Coimbra

et al. 2020

Radiology Research and Practice

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Liver volume and function after hepatectomies are directly correlated to postoperative complications and mortality. Consequently contemporary liver surgery has focused on reaching an adequate future liver remnant so as to diminish postoperative morbidity and mortality. Portal vein embolization has evolved and is the standard of care as a liver regenerative strategy in many surgery departments worldwide before major liver resections. Different embolic materials have been used for portal vein embolization including gelfoam, ethanol, polyvinyl-alcohol particles, calibrated microspheres, central vascular plugs, coils, n-butyl-cyanoacrylate glue, fibrin glue, polidocanol-foam, alcoholic prolamin solution, and ethylene vinyl alcohol copolymer, as sole occluders or in varied combinations. While to date there has been no prospective controlled trial comparing the efficacy of different embolic materials in portal vein embolization, retrospective data insinuates that the use of n-butyl-cyanoacrylate and absolute ethanol produces higher contralateral liver hypertrophies. In this review, we evaluated publications up to August 2019 to assess the technical and regenerative results of portal vein embolization accomplished with different embolic materials. Special attention was given to specific aspects, advantages, and drawbacks of each embolic agent used for portal vein embolization, its liver regenerative performance, and its influence on patient outcome.

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“…Hence, for patients undergoing major hepatic resection a minimum remnant liver volume to total liver volume ratio (RLV-TLV) of 30% respectively remnant liver volume to body weight ratio (RLV-BWR) of 0.5% is recommended to avoid PHLF [4]. Preoperative portal vein embolization (PVE) is considered the gold standard to mediate hypertrophy of the FLR and thereby reduce the risk of developing PHLF [5]. In case of inadvertent non-target thrombosis of the left portal vein during embolization, few treatment options remain for the patient aiming for right trisectionectomy [6].…”

Section: Introductionmentioning

confidence: 99%

Surgical Removal of Inadvertent Portal Thrombosis by Rescue-ALPPS for Perihilar Cholangiocarcinoma

Li¹

2019

IJSCR

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Introduction:Treatment of perihilar cholangiocarcinoma (PHC) usually requires extended resection after inducing hypertrophy of the future liver remnant (FLR). Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can achieve rapid hypertrophy of the FLR. Though, due to significant morbidity and mortality, portal vein embolization (PVE) is considered gold standard. Despite remaining controversies, ALPPS might suit as reserve in patients who failed to achieve adequate hypertrophy of the FLR or suffered complications following PVE. We illustrate a rescue-ALPPS after inadvertent nontarget thrombosis of the FLR following PVE in a patient with PHC. Presentation of Case:A 67-year-old patient requiring right trisectionectomy for PHC Bismuth type IV suffered inadvertent nontarget portal thrombosis of the FLR following PVE. Subsequently, insufficient FLR hypertrophy prevented the planned surgical resection. ALPPS procedure with concomitant thrombectomy of the left portal vein was used as a rescue strategy for this patient. Discussion:Since ALPPS is associated with significant limitations, especially in patients with PHC, this approach remains controversial. However, surgery still remains the only curative option for patients with PHC and thus, in case of inadequate hypertrophy of the FLR or technical failure following PVE, these patients lack further treatment options. Recent technical refinements and methods of improved patient selection have the potential to emend outcomes of ALPPS in experienced centres. Conclusion:ALPPS should be considered as reasonable rescue strategy not only in case of insufficient hypertrophy of the FLR but also in the event of technical failure or complications following PVE, even in patients with PHC.

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Portal vein embolization in extended liver resection

Cited by 30 publications

References 67 publications

Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

Preoperative Portal Vein Embolization in Hepatic Surgery: A Review about the Embolic Materials and Their Effects on Liver Regeneration and Outcome

Surgical Removal of Inadvertent Portal Thrombosis by Rescue-ALPPS for Perihilar Cholangiocarcinoma

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