Portal vein embolization: rationale, technique and future prospects

Abdalla, Eddie K.; Hicks, Marshall E.; Vauthey, Jean Nicolas

doi:10.1046/j.1365-2168.2001.01658.x

Cited by 392 publications

(285 citation statements)

References 73 publications

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“…2,3,25,26,29 Currently, FLR size and factors potentially compromising liver function (cirrhosis or hepatitis and previous chemotherapy) are criteria by which patients are selected for portal vein embolization. 27,28,30 Small remnant liver volumes after hepatectomy may negatively influence outcome for different reasons. First, hepatic reserve may be reduced because of preexisting liver disease, and the liver remaining after hepatectomy may not provide sufficient function despite apparent adequate volume.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with bile duct tumors, measurement of the compromised liver (because of bile duct dilatation, cholangitis, or vascular obstruction) may not be relevant using this formula. 2,19,27,28 An alternate method of assessing the remnant liver similar to the method used before transplantation, which does not include tumor volume or resected volume, recently has been proposed. It is based on the FLR-TLV ratio.…”

Section: Discussionmentioning

confidence: 99%

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Body surface area and body weight predict total liver volume in Western adults

Vauthey¹

2002

Liver Transplantation

544

436

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Computed tomography (CT) is used increasingly to measure liver volume in patients undergoing evaluation for transplantation or resection. This study is designed to determine a formula predicting total liver volume (TLV) based on body surface area (BSA) or body weight in Western adults. TLV was measured in 292 patients from four Western centers. Liver volumes were calculated from helical computed tomographic scans obtained for conditions unrelated to the hepatobiliary system. BSA was calculated based on height and weight. Each center used a different established method of three-dimensional volume reconstruction. Using regression analysis, measurements were compared, and formulas correlating BSA or body weight to TLV were established. A linear regression formula to estimate TLV based on BSA was obtained: TLV ‫؍‬ I n the past decade, the role of computed tomography (CT) has extended beyond its use for liver imaging to include three-dimensional volumetric measurement before liver transplantation or major hepatic resection. [1][2][3][4] This has been possible because of a close correlation between the volume obtained by three-dimensional reconstruction of computed tomographic images and actual liver volume. 5 In a recent Japanese study, a formula that enables calculation of total liver volume (TLV) from body surface area (BSA) was generated after study of CT-based three-dimensional volumetric measurement of livers of children and adults. This formula has been applied to calculate the graft to TLV ratio for living related donor liver transplantation 4,6 and the future liver remnant (FLR) to TLV ratio before liver resection. 2 However, the formula has not gained general acceptance at Western centers, and its accuracy has been questioned because of Western autopsy measurements that indicate on average a TLV of 323 cm 3 greater than expected based on the Japanese formula. 7 In addition, body weight, rather than BSA, has been used to estimate graft volume before liver transplantation, particularly donorrecipient weight ratio. [8][9][10] However, to our knowledge, the correlation between body weight and TLV has not been evaluated.In addition to the issue of liver size match, the goal of preoperative liver volume estimation is to estimate hepatic metabolic demands of an individual patient. 11 Thus, a method that estimates appropriate volume based on patient characteristics (e.g., patient weight or BSA) in combination with a measure of liver volume (by CT) is desirable. Although caloric needs, total body water, and extracellular water correlate more closely to BSA than body weight in children, differences are minor. 12,13 Therefore, either weight or BSA could provide a standard means to estimate liver function, as well as size, before resection or transplantation.We designed a multicenter study to evaluate the correlation between TLV and BSA or body weight in Western patients with normal livers who underwent CT for conditions unrelated to the hepatobiliary system. The newly derived formula based on BSA then was

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Body surface area and body weight predict total liver volume in Western adults

Vauthey¹

2002

Liver Transplantation

544

436

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“…Even after preoperative chemotherapy or PVE, some patients cannot become eligible for complete CRLM resection through a single hepatectomy. PVE combined with a two-stage resection may be helpful in such circumstances [25]. However, for patients who cannot undergo liver resection because of extensive liver metastases and inadequate remnant liver volume, RFA can play an important role when combined with liver resection [26].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Tumor Response and Resection Rates in Unresectable Colorectal Liver Metastases Following Neoadjuvant Chemotherapy with Cetuximab

Somashekhar

Ashwin

Zaveri

et al. 2015

Indian J Surg Oncol

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To investigate efficacy and safety of cetuximab combined with neo adjuvant chemotherapy regimen in patients with unresectable colorectal liver. This was a prospective trial with rate of Ro liver metastases resection as primary end point. Between January 2010 and December 2014, 46 patients with unresectable liver metastases from colon or rectum were enrolled. Patients received Cetuximab along with neoadjuvant chemotherapy where 34 (74 %) and 12 (26 %) patients received FOLFOX and FOLFIRI, respectively. They were assessed for response after 2-3 cycles by CT scan. Patients with resectable disease were offered liver surgery within 3-6 weeks of the last treatment cycle. The primary end point was resection rate of liver metastases, which was evaluated in all patients. Secondary end points were response rate according to Response evaluation criteria in solid tumors (RECIST) criteria, perioperative morbidity and mortality. An objective response was observed in 28 (60.9 %) patients. Seven (15.2 %) patients were reported radiologically to have a complete response (CR); 21 (45.7 %) patients had radiological partial response (PR). An additional 12 patients (26.1 %) demonstrated stable disease (SD) and only six patients (13.0 %) had disease progression (PD). Microscopically complete resections (R0 resection) was performed in all 28 patients (60.9 %). The most frequent toxicities were skin rash and diarrhoea. There was no operative mortality. Chemotherapy with cetuximab yields high response rates compared with historical controls, and leads to significantly increased resectability. Complete resection of previously unresectable colorectal liver metastases can be performed with minimal morbidity and mortality. This therapeutic strategy involves a multimodal approach.

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“…Patients for PVE should be selected carefully and PVE should be avoided in patients with an adequate future liver remnant. At present, selection of patients for PVE is based on CT/MRI volumetry, and 30% of future liver remnant volume is considered adequate in patients with normal liver and 40% in patients with abnormal liver function (Abdalla et al, 2001). Incorporating hepatic functional studies, such as hepatic scintigraphy (Dinant et al, 2007) and biopsy of normal liver, to evaluate histological abnormality (steatosis, steatohepatitis and cholestasis) in patients with borderline future liver remnant will provide further information on the quality of the residual liver and may avoid unnecessary PVE.…”

Section: P=0442mentioning

confidence: 99%

Effect of portal vein embolisation on the growth rate of colorectal liver metastases

et al. 2009

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Portal vein embolisation (PVE) is used to increase the remnant liver volume before major liver resection for colorectal metastases. The resection rate after PVE is 60 -70%, mainly limited by disease progression. The effect of PVE on tumour growth rate has not been investigated. The objective of this study was to compare the growth characteristics of resected colorectal liver metastases in patients undergoing pre-operative PVE with those of matched controls who had not undergone PVE. There were 22 patients who had undergone preoperative PVE and 20 matched controls. Tumour growth rate was calculated by the change in tumour volume (CT/MRI volumetric assessment) from diagnosis to resection. Resected histological specimens were examined by two histopathologists independently for cell differentiation, percentage tumour cell necrosis and mitotic rate. Immunochemical staining with Ki67 was carried out using the MIB-1 monoclonal antibody and quantified using a Glasgow cell-counting graticule. The groups were comparable in demographics, stage of primary disease, volume of liver metastases at presentation and chemotherapy received. The tumour growth rate calculated from imaging was more rapid in the PVE group compared with that in controls (control: 0.05 ± 0.25 ml day À1 , PVE: 0.36 ± 0.68 ml day À1 , P ¼ 0.06). Histology showed no difference in the degree of differentiation, extent of necrosis or apoptosis between the two groups. However, mitotic rate was higher post PVE, as was the proliferation index Ki67 (P ¼ 0.04). This study has confirmed that tumour growth rate increased following PVE and that this is related to increased tumour cell division.

show abstract

Portal vein embolization: rationale, technique and future prospects

Abstract: This treatment does not increase the risks associated with major liver resection. It may be indicated in selected patients before major resection. Future prospective studies are needed to define more clearly the indications for this evolving technique.

Cited by 392 publications

References 73 publications

Body surface area and body weight predict total liver volume in Western adults

Body surface area and body weight predict total liver volume in Western adults

Assessment of Tumor Response and Resection Rates in Unresectable Colorectal Liver Metastases Following Neoadjuvant Chemotherapy with Cetuximab

Effect of portal vein embolisation on the growth rate of colorectal liver metastases

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