In situ liver transection with portal vein ligation for rapid growth of the future liver remnant in two-stage liver resection

Abstract

Background: Portal vein embolization (PVE) has become a standard procedure to increase the future liver remnant (FLR) and enable curative resection of initially unresectable liver tumours. This study investigated the safety and feasibility of a new two-stage liver resection technique that uses in situ liver transection (ISLT) and portal vein ligation before completion hepatectomy. Conclusion:ISLT is an effective and reliable technique to induce rapid growth of the FLR, even in patients with insufficient volume increase after PVE.

Asociación De La Partición Hepática Y Ligadura De La Vena Portal Para Hepatectomía Por Etapas, Un Nuevo Procedimiento en Cirugía Hepática

“…Luego de una mediana de intervalo de 9 días, la mediana de volumen del lóbulo izquierdo fue de 536 cc, con un delta de volumen de 225 cc, y un incremento de volumen de 74% 3 . numerosos artículos y comentarios han sido posteriormente publicados al respecto 6,[16][17][18][19][20][21] .…”

“…En este caso el rol de la bipartición es evidente, ya que no se produjo hipertrofia del lóbulo izquierdo cuando sólo se ligó la vena porta derecha. Los resultados obtenidos a corto plazo en nuestra paciente son similares a los reportados en la literatura existente 6,[16][17][18][19][20][21] .…”

Two-stage hepatectomy for liver metastasis from colorectal cancer

“…A B tumour board. 7,8 These patients must be deemed medically fit by an anesthesiologist and internal medicine specialist to withstand the back-to-back major abdominal surgeries involved. Previous chemotherapy is not a contraindication; however, caution should be taken if the patient has received more than eight cycles (i.e., because of increased risk of liver toxicity).…”

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

“…The multidisciplinary team must determine whether a margin-negative resection is achievable and that an adequate amount of liver with intact vascular inflow and outflow and biliary drainage will remain post-resection in order to prevent post-operative hepatic failure. The volume of liver parenchyma that will remain after resection, i.e., the future liver remnant (FLR), is of paramount importance in hepatic resections [11][12][13]. Conventionally 20 % of the total liver volume has been regarded as the minimum safe FLR in a patient with normal hepatic function [7]; however, an FLR of 30-40 % is necessary if the patient has received cytotoxic chemotherapy, since chemotherapeutic agents used to treat CRC cause hepatic injury, such as steatosis and sinusoidal obstruction with oxaliplatin and steatohepatitis with irinotecan [12,14].…”

“…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.…”