Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis

Heil, Jan; Korenblik, Remon; Heid, F.; Bechstein, Wolf O.; Bemelmans, M. H. A.; Binkert, Christoph A.; Björnsson, Bergþór; Breitenstein, Stefan; Detry, Olivier; Dili, Alexandra; Dondelinger, Robert; Gérard, Laurent; Gimenez-Maurel, T; Guiu, Boris; Heise, Daniel; Hertl, Martin; Kalil, J.; Klein, J; Lakoma, Anna; Neumann, Ulf; Olij, B.; Pappas, Sam G.; Sandström, Per; Schnitzbauer, Andreas A.; Serrablo, Alejandro; Tasse, J.; Leij, Christiaan van der; Metrakos, Peter; Dam, R. Van; Schadde, Erik

doi:10.1093/bjs/znaa149

Cited by 58 publications

(66 citation statements)

References 31 publications

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“…No patients were unable to be resected due to insufficient growth, but patients with an sFLR < 20% relatively more often needed an additional volume-expanding procedure prior to resection. This is in line with earlier reports [ 20 ], and it might be a useful cutoff for considering more invasive strategies upfront such as ALPPS or liver venous deprivation–simultaneous hepatic and portal vein embolization (double vein embolization) [ 22 , 23 ].…”

Section: Discussionsupporting

confidence: 90%

Portal Vein Embolization Using N-Butyl Cyanoacrylate-Glue: What Impact Does a Central Vascular Plug Have?

Carling

Røsok

Berger

et al. 2021

Cardiovasc Intervent Radiol

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Purpose To examine if the addition of a central vascular plug (CVP) to portal vein embolization (PVE) with N-butyl cyanoacrylate-glue (NBCA) increases future liver remnant (FLR) growth. Material and Methods This is a single-center retrospective study of 115 consecutive patients with colorectal liver metastases undergoing PVE in 2013–2019. All patients were embolized with NBCA as the main embolic agent. In 2017–2019 NBCA was combined with a CVP in the central part of the right portal vein. Growth of the FLR and standardized FLR (sFLR) including degree of hypertrophy (DH) and kinetic growth rate (KGR) were analyzed, as well as procedure data such as use of cone-beam CT (CBCT), dose area product (DAP), fluoroscopy time and contrast dose. Results A total of 40 patients (35%) underwent PVE with a combination of CVP and NBCA. The DH was higher in these patients after 4 weeks, mean 13.6% (SD 7.8) vs. 10.5% (SD 6.4; p = 0.022), verified in multivariate analysis (coefficient 4.1, p = 0.015). A CVP did not significantly increase the resection rate (90% vs 82%, p = 0.4). Cone beam CT was used in 65 patients (57%). Use of CBCT did not affect FLR growth, and fluoroscopy time and contrast doses were not different in patients having a CBCT or not. Slightly lower DAP (median 3375 vs. 4499 cGy*cm2; p = 0.09) was seen in procedures where CBCT was used. Conclusion A CVP in addition to NBCA embolization was associated with increased growth of the FLR compared to NBCA alone.

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Section: Discussionsupporting

confidence: 90%

Portal Vein Embolization Using N-Butyl Cyanoacrylate-Glue: What Impact Does a Central Vascular Plug Have?

Carling

Røsok

Berger

et al. 2021

Cardiovasc Intervent Radiol

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“…Even for extended resection, the embolization of the right and middle hepatic vein is described [42]. The role of hepatic vein embolization for iCCA needs to be investigated, but seems to be a promising tool for future resection strategies [43].…”

Section: Discussionmentioning

confidence: 99%

Complex Liver Resections for Intrahepatic Cholangiocarcinoma

Reese

Pagel

Bause

et al. 2021

JCM

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The only curative treatment option for intrahepatic cholangiocarcinoma (iCCA) is liver resection. Due to central tumor localization and vascular invasion, complex liver resections play an important role in curative treatment. However, the long-term outcomes after complex liver resection are not known. Methods: A retrospective cohort study was conducted for all patients undergoing liver surgery for iCCA. Complex liver resections included ante situm resections, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and major liver resection with vascular reconstructions. Results: Forty-nine patients (34%) received complex liver resection, 66 patients (46%) received conventional liver resection and 28 patients (20%) were not resectable during exploration. Preoperative characteristics were not different between the groups, except for Union for International Cancer Control (UICC) stages. The postoperative course for complex liver resections was associated with more complications and perioperative mortality. However, long-term survival was not different between complex and conventional resections. Independent risk factors for survival were R0 resections and UICC stage. Four patients underwent ante situm resection without any mortality. Conclusions: Complex liver resections are justified in selected patients and survival is comparable with conventional liver resections. Survival in iCCA is affected by UICC stage or resections margins and not by the complexity of the case.

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“…In one series, simultaneous portal and hepatic vein embolization was compared with ALPPS ( 79 ). Except for the series by the Montpellier group ( 26 , 66 , 73 , 77 ) and one series from Bordeaux ( 76 ), all other groups decided to forego the additional liquid embolization of the venous system ( 74 , 75 , 78 ), most likely due to the risk of liquid embolization of the pulmonary vein. The Bordeaux group gave their procedure a name different from “LVD” and “eLVD”: “RASPE” (radiological simultaneous portohepatic vein embolization) ( 76 ), while using additional liquid embolization like in the original LVD technique by Guiu et al ( 26 ).…”

Section: Simultaneous Portal and Hepatic Vein Embolization (Pve/hve)mentioning

confidence: 99%

Current trends in regenerative liver surgery: Novel clinical strategies and experimental approaches

2022

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Liver resections are performed to cure patients with hepatobiliary malignancies and metastases to the liver. However, only a small proportion of patients is resectable, largely because only up to 70% of liver tissue is expendable in a resection. If larger resections are performed, there is a risk of post-hepatectomy liver failure. Regenerative liver surgery addresses this limitation by increasing the future liver remnant to an appropriate size before resection. Since the 1980s, this surgery has evolved from portal vein embolization (PVE) to a multiplicity of methods. This review presents an overview of the available methods and their advantages and disadvantages. The first use of PVE was in patients with large hepatocellular carcinomas. The increase in liver volume induced by PVE equals that of portal vein ligation, but both result only in a moderate volume increase. While awaiting sufficient liver growth, 20%–40% of patients fail to achieve resection, mostly due to the progression of disease. The MD Anderson Cancer Centre group improved the PVE methodology by adding segment 4 embolization (“high-quality PVE”) and demonstrated that oncological results were better than non-surgical approaches in this previously unresectable patient population. In 2012, a novel method of liver regeneration was proposed and called Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS). ALPPS accelerated liver regeneration by a factor of 2–3 and increased the resection rate to 95%–100%. However, ALPPS fell short of expectations due to a high mortality rate and a limited utility only in highly selected patients. Accelerated liver regeneration, however, was there to stay. This is evident in the multiplicity of ALPPS modifications like radiofrequency or partial ALPPS. Overall, rapid liver regeneration allowed an expansion of resectability with increased perioperative risk. But, a standardized low-risk approach to rapid hypertrophy has been missing and the techniques used and in use depend on local expertise and preference. Recently, however, simultaneous portal and hepatic vein embolization (PVE/HVE) appears to offer both rapid hypertrophy and no increased clinical risk. While prospective randomized comparisons are underway, PVE/HVE has the potential to become the future gold standard.

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Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis

Cited by 58 publications

References 31 publications

Portal Vein Embolization Using N-Butyl Cyanoacrylate-Glue: What Impact Does a Central Vascular Plug Have?

Portal Vein Embolization Using N-Butyl Cyanoacrylate-Glue: What Impact Does a Central Vascular Plug Have?

Complex Liver Resections for Intrahepatic Cholangiocarcinoma

Current trends in regenerative liver surgery: Novel clinical strategies and experimental approaches

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