Preoperative Portal Vein Embolization for Major Liver Resection

Abstract

PVE is a safe and effective procedure in inducing liver hypertrophy to prevent postresection liver failure due to insufficient liver remnant.

Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure

“…Portal vein embolization induces atrophy of the liver to be resected and hypertrophy of the liver that will remain (i.e. increases the future liver remnant) (18). Similarly, two-stage hepatectomies in CRLM involve delayed re-hepatectomy after hypertrophy of the residual liver and may be used for large bilateral lesions in which a one stage resection of all the involved segments would lead to liver failure (19).…”

Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases

“…PVE can be performed using either transileocolic portal vein embolization or percutaneous transhepatic portal vein embolization (preferred). On average, PVE produces a 25-80 % increase in the absolute volume of the non-embolized liver [11,[38][39][40]. PVE has also been shown to be safe and effective in patients that are currently undergoing neoadjuvant chemotherapy.…”

“…After a median of 30 days, patients on neoadjuvant chemotherapy were found to have similar liver hypertrophy compared to patients not undergoing chemotherapy. A large meta-analysis by Abulkhir et al identified 37 studies with 1088 patients [38]. Overall morbidity for PVE was 2.2 % and 85 % of patients underwent laparotomy with 83 % resectability in patients who underwent PVE.…”

«saving» a Two-Stage Liver Resection by the Alpps Type

“…При этом через 7-8 нед после редукции кровотока в правой ветви во-ротной вены наступает гипертрофия остающихся от-делов печени, что позволяет выполнить оперативное вмешательство в радикальном объеме. Однако реа-лизовать 2-й этап запланированной двухэтапной ре-зекции печени удается не более чем у 70-75% паци-ентов, что, в первую очередь, связано с отсутствием гипертрофии остающихся отделов печени (FLR) [1][2][3]. Исследователями было доказано, что при FLR мень-ше 20% при состоятельной паренхиме печени и 40% при функциональном (неоадъювантная химиотера-пия, цирроз) поражении печени реализация хирур-гических вмешательств сопряжена с крайне высоким риском развития печеночной недостаточности [4][5][6].…”