Portal Vein Embolization Followed by Right-Side Hemihepatectomy for Hepatocellular Carcinoma Patients: A Japanese Multi-Institutional Study

Beppu, Teruhiko; Okabe, Hidetoshi; Okuda, K; Eguchi, Susumu; Kono, Kenji; Taniai, Nobuhiko; Ueno, S.; Shirabe, Ken; Ohta, Masayuki; Kondo, Kazuhiro; Nanashima, Atsushi; Noritomi, Tomoaki; Okamoto, Kohji; Kikuchi, Ken; Baba, Hideo; Fujioka, Hikaru

doi:10.1016/j.jamcollsurg.2016.03.023

Cited by 25 publications

(38 citation statements)

References 33 publications

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“…It is currently recommended that the minimum sFLR after hepatic resection are 20%-25% in normal livers, but 40% in compromised livers (such as cirrhosis, steatosis or chronic hepatitis)[ 41 - 44 ]. In Japan, PVE is performed when the non-tumor resection rate is > 60% for patients with normal ICGR15 and > 40% for patients with 10% < ICGR15 ≤ 20%[ 45 ]. Furthermore, PVE is rarely performed before an extended left hepatectomy or left trisectionectomy because the right posterior section often occupies approximately 30% of the TLV[ 46 ].…”

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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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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“…Similarly, Huiskens et al 73 compared propensity score-matched cohorts and found that PVE does not significantly impact 3-year disease-free survival or 5-year OS for patients undergoing major liver resection for colorectal liver metastases. Another propensity score-matched analysis performed by Beppu et al 74 found that extrahepatic recurrences were less common in patients who underwent PVE compared to those who did not (18.1% vs 38.8%).…”

Section: Surgical and Oncologic Outcomesmentioning

confidence: 98%

Portal vein embolization prior to hepatectomy: Techniques, outcomes and novel therapeutic approaches

Hung

McWilliams

2018

Int J Gastrointest Interv

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Hepatectomy plays a pivotal role in the management of primary and secondary malignancies of the liver, and offers a curative option for the patient. Postoperative liver failure is a severe complication of liver resection, particularly for patients with underlying liver disease. Portal vein embolization (PVE) is a well-established preoperative technique that redirects blood flow to the anticipated remaining liver after resection in an effort to improve the functional hepatic reserve. PVE has improved the safety of hepatectomy and has extended surgical candidacy to patients who previously would have been ineligible for resection because of insufficient remnant liver volume. This article reviews the following aspects of PVE; indications, contraindications, liver volumetry, approaches, embolization agents, recent outcomes data, and areas of active research including adjunctive therapies and temporary PVE.

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“…Beppu et al [12] reported that even though patients with HCC who underwent preoperative PVE and right-sided hemihepatectomy had a significantly larger resected liver volume on admission, their long-term prognosis was comparable to that of patients who underwent upfront hepatectomy. They also reported that PVE might decrease extrahepatic recurrences.…”

Section: Portal Vein Embolization Before Major Hepatectomymentioning

confidence: 99%

Portal Vein Embolization: History and Current Indications

et al. 2017

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Portal vein embolization (PVE) was first adapted for patients undergoing major hepatectomy for hepatocellular carcinoma (HCC). In these patients, PVE caused hypertrophy of the unaffected liver and increased the volumetric ratio of future liver remnant (FLR) to total liver volume. ^99mTechnetium-galactosyl human serum albumin (^99mTc-GSA) scintigraphy revealed that PVE also induced a shift in hepatic function from the embolized part to the nonembolized part of the liver. Various hepatobiliary malignancies can be treated using PVE, and PVE is increasingly being used to expand the indication for major hepatectomy in patients with initially insufficient FLR volume or function. The indication for PVE is determined by the underlying liver function and standardized FLR volume. In patients with chronic hepatitis, the histologic inflammatory activity was negatively correlated with the increase in FLR volume, and PVE is not suitable for patients with high serum 7s collagen concentrations (>8 ng/ml). This finding may predict the efficacy of PVE. PVE before major hepatectomy can act as a tolerance test to avoid postoperative hepatic failure. PVE also improved long-term survival after liver resection in patients with HCC. Presently, PVE is a safe and useful treatment for patients undergoing major hepatectomy.

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Portal Vein Embolization Followed by Right-Side Hemihepatectomy for Hepatocellular Carcinoma Patients: A Japanese Multi-Institutional Study

Cited by 25 publications

References 33 publications

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

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

Portal vein embolization prior to hepatectomy: Techniques, outcomes and novel therapeutic approaches

Portal Vein Embolization: History and Current Indications

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