Optimization of the future remnant liver: review of the current strategies in Europe

Abstract

Liver resection still represent the treatment of choice for liver malignancies, but in some cases inadequate future remnant liver (FRL) can lead to post hepatectomy liver failure (PHLF) that still represents the most common cause of death after hepatectomy. Several strategies in recent era have been developed in order to generate a compensatory hypertrophy of the FRL, reducing the risk of post hepatectomy liver failure. Portal vein embolization, portal vein ligation, and ALLPS are the most popular techniques historically adopted up to now. The liver venous deprivation and the radio-embolization are the most recent promising techniques. Despite even more precise tools to calculate the relationship among volume and function, such as scintigraphy with 99m Tc-mebrofenin (HBS), no consensus is still available to define which of the above mentioned augmentation strategy is more adequate in terms of kind of surgery, complexity of the pathology and quality of liver parenchyma. The aim of this article is to analyse these different strategies to achieve sufficient FRL.

Aktuelle Studien und Evidenz zum Cholangiokarzinom

“…Hierbei handelt es sich um eine 2-zeitige Leberresektion, bei der in einer 1. Operation eine Ligatur des kontralateralen Pfortaderhauptastes durchgeführt und die zu resezierenden Leberanteile vom restlichen Lebergewebe getrennt, aber in situ belassen werden [3,12]. Es erfolgte nach ausreichender Hypertrophie des verbleibenden Leberlappens eine 2.…”

Establishment of a Rat Model of Liver Venous Deprivation: Simultaneous Portal and Hepatic Vein Ligation

“…Thus approach modulates the liver to achieve an adequate FLR by the early-step procedure and performing major hepatectomy at a later stage. [1][2][3] Based on this concept, several liver preparation approaches have been proposed, such as portal vein ligation or embolization (PVL or PVE), associating liver partition and PVL for staged hepatectomy (ALPPS), and liver venous deprivation (LVD). [1][2][3][4] Those modulation methods were designed to enlarge the volume of the FLR and reduce the volume of the future liver excised (FLE).…”

“…[1][2][3] Based on this concept, several liver preparation approaches have been proposed, such as portal vein ligation or embolization (PVL or PVE), associating liver partition and PVL for staged hepatectomy (ALPPS), and liver venous deprivation (LVD). [1][2][3][4] Those modulation methods were designed to enlarge the volume of the FLR and reduce the volume of the future liver excised (FLE). LVD was first introduced by Guiu et al 5 in 2016, and the novel technique combined portal vein embolization (PVE) and hepatic vein embolization (HVE) via radiologic intervention during the same procedure.…”

“…7,8 PVE has become a widely used but inefficient approach to stimulate hypertrophy of FLR, and the ALPPS procedure seems to be more aggressive and efficient but is accompanied by more complications. [1][2][3]9 The safety and efficacy of LVD remain unclear because of a relatively limited number of studies. A recent multicenter study compared LVD with PVE and reported that LVD achieved better FLR hypertrophy (59% vs. 48%; p=0.020) and resectability (90% vs. 68%; p=0.007) than PVE.…”

Desarrollo de un modelo animal de atrofia-hipertrofia y daño hepático tras radioembolización lobar con YTRIO-90 en conejos

“…Uno de los factores limitantes más importantes es la escasez de remanente hepático que puede condicionar una insuficiencia hepática, la causa más común de mortalidad posquirúrgica [42]. Se considera seguro un futuro remanente hepático (FLR-"Future liver remnant") ≥ 20 % del volumen en caso de hígado sano, ≥ 30-40 % si existe una esteatosis severa subyacente y/o colestasis, y ≥ 50 % en pacientes cirróticos [43].…”