Improved liver function after portal vein embolization and an elective right hepatectomy

Meier, Raphaël; Toso, Christian; Terraz, Sylvain; Bréguet, Romain; Berney, Thierry; Andrès, Axel; Jannot, Anne‐Sophie; Rubbia‐Brandt, Laura; Morel, Philippe; Majno, Pietro

doi:10.1111/hpb.12501

Cited by 9 publications

(8 citation statements)

References 48 publications

(47 reference statements)

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“…Meier et al. , interestingly, demonstrated that preoperative PVE positively influenced postoperative liver function independently from changes expected from increase in liver volume alone, suggesting that PVE not only increases the postoperative volume but also the functional capacity of the FRL.…”

Section: Resultsmentioning

confidence: 99%

Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high‐volume centers with a combined experience of 2,778 cases

Chaudhary

Higuchi

Nagino

et al. 2019

J Hepato Biliary Pancreat

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Background In Japan, strategies for preoperative management of perihilar cholangiocarcinoma (PHC) have evolved over the last decade; the operative mortality has significantly reduced to <5%. Methods A questionnaire was sent to 10 institutions based on their case volume. Questionnaire was based on: (1) preoperative biliary drainage, (2) bile replacement, (3) role of synbiotics, (4) remnant liver volume enhancement, (5) predicted remnant liver function, (6) imaging, (7) nutrition, and (8) role of Inchinkoto. Results The median case volume was 226 (range 105-889) cases, respectively. Eight institutions preferred endoscopic nasobiliary drainage and two preferred endoscopic biliary stenting for biliary drainage. Nine used bile replacement within 2-3 days of biliary drainage. Four used synbiotics preoperatively. The median cutoff value for future remnant liver volume and serum total bilirubin, at which portal vein embolization (PVE) is done, is <40% and <4 mg/dl. The median interval between PVE and surgery was 3-4 weeks. To predict remnant liver function, indocyanine green retention (n = 8) and clearance rate (n = 2) were mainly used. Five used Inchinkoto to improve liver function. Nine used multidetector computed tomography and direct cholangiography for surgical planning. Conclusion With appropriate preoperative management of PHC, surgical morbidity and mortality can be reduced. This survey can provide recommendations to improve PHC perioperative outcomes.

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Section: Resultsmentioning

confidence: 99%

Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high‐volume centers with a combined experience of 2,778 cases

Chaudhary

Higuchi

Nagino

et al. 2019

J Hepato Biliary Pancreat

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“…It is very important to figure out what is the mechanism of the regenerative ability of the liver after PVE, especially the relation between liver function improvement and liver volume increment. Meier et al[ 56 ] retrospectively compared post-right hepatectomy outcomes in 28 patients with and 53 without PVE in a non-randomized study, suggesting that the immediate post-operative liver function per unit of volume in patients with PVE was better than those without PVE. This finding was also similar to Farges et al[ 47 ] who found the improved post-operative liver function in patients with PVE compared with those without PVE in terms of the chronic liver.…”

Section: Resultsmentioning

confidence: 99%

Conversion therapy and suitable timing for subsequent salvage surgery for initially unresectable hepatocellular carcinoma: What is new?

Zhang

Luo

et al. 2018

WJCC

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AIMTo review the conversion therapy for initially unresectable hepatocellular carcinoma (HCC) patients and the suitable timing for subsequent salvage surgery.METHODSA PubMed search was undertaken from 1987 to 2017 to identify articles using the keywords including “unresectable” “hepatocellular carcinoma”, ”hepatectomy”, ”conversion therapy”, “resection”, “salvage surgery” and “downstaging”. Additional studies were investigated through a manual search of the references from the articles. The exclusion criteria were duplicates, case reports, case series, videos, contents unrelated to the topic, comments, and editorial essays. The main and widely used conversion therapies and the suitable timing for subsequent salvage surgery were discussed in detail. Two members of our group independently performed the literature search and data extraction.RESULTSLiver volume measurements [future liver remnant (FLR)/total liver volume or residual liver volume/bodyweight ratio] and function tests (scoring systems and liver stiffness) were often performed in order to justify whether patients were suitable candidates for surgery. Successful conversion therapy was usually defined as downstaging the tumor, increasing FLR and providing subsequent salvage surgery, without increasing complications, morbidity or mortality. The requirements for performing salvage surgery after transcatheter arterial chemoembolization were the achievement of a partial remission in radiology, the disappearance of the portal vein thrombosis, and the lack of extrahepatic metastasis. Patients with a standardized FLR (sFLR) > 20% were good candidates for surgery after portal vein embolization, while other predictive parameters like growth rate, kinetic growth rate were treated as an effective supplementary. There was probably not enough evidence to provide a standard operation time after associating liver partition and portal vein ligation for staged hepatectomy or yttrium-90 microsphere radioembolization. The indications of any combinations of conversion therapies and the subsequent salvage surgery time still need to be carefully and comprehensively evaluated.CONCLUSIONConversion therapy is recommended for the treatment of initially unresectable HCC, and the suitable subsequent salvage surgery time should be reappraised and is closely related to its previous therapeutic effect.

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“…Preoperative portal vein embolization (PVE) before hepatice resection has been widely applied to induce the hypertrophy of FLR for patients undergoing a major resection 2 . Sequential preoperative TACE and PVE before major hepatic resection have been shown to strengthen the effect of PVE and simultaneously prevent tumor progression during the waiting time 3 . In recent years, the associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) has been proposed as a novel approach to induce the rapid liver regeneration, resulting in increasing the chance of resectability 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Resection options are often limited by a reduced hepatic reserve. With recent advances of perioperative management and surgical techniques, hepatic resection has been performed safely for selected patients with large HCC 3, 4. For those patients with large HCC who can be resected, the overall survival has been shown to be better than the nonsurgical treatment 5 …”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis of long term outcomes in patients undergoing hepatic resection for large (>5 cm) hepatocellular carcinoma

Zhao¹,

Wu²,

Liu

et al. 2016

HPB

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AimThe treatment of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. The aim of this study was to report short and long term outcomes and analyze the factors associated with long term survival for patients who underwent hepatic resection for large HCC.MethodsAll patients who underwent hepatic resection for large HCC at the department of Hepato-Pancreato-Biliary Surgery of the First Affiliated Hospital of Anhui Medical University between August 2005 and December 2011 were identified and included for analysis. Demographic and operative data, pathological findings and post-operative outcomes were entered into a computer database. Prognostic factors were analyzed by univariate and multivariate analysis.ResultsNinety-nine patients were included for analysis. Two patients died within 30 days of surgery secondary to hepatic failure. The 1-, 3-, 5-year disease-free survival and overall survival rates following hepatic resection were 67%, 49%, 37% and 77%, 56%, 43%, respectively. Poor histological grade was the only independent predictor of a reduced 5-year disease-free survival. Spontaneous tumor rupture and tumor recurrence were independent predictors of a reduced 5-year overall survival.ConclusionsFor selected patients with large HCC, hepatic resection can be performed safely and effectively with moderate expectation of long term survival. True cure however remains rare.

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Improved liver function after portal vein embolization and an elective right hepatectomy

Cited by 9 publications

References 48 publications

Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high‐volume centers with a combined experience of 2,778 cases

Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high‐volume centers with a combined experience of 2,778 cases

Conversion therapy and suitable timing for subsequent salvage surgery for initially unresectable hepatocellular carcinoma: What is new?

A retrospective analysis of long term outcomes in patients undergoing hepatic resection for large (>5 cm) hepatocellular carcinoma

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