Portal vein embolization with plug/coils improves hepatectomy outcome

Malinowski, Maciej; Geisel, Dominik; Stary, Victoria; Denecke, Timm; Seehofer, Daniel; Jara, Maximillian; Baron, Annekathrin; Pratschke, Johann; Gebauer, Bernhard; Stockmann, Martin

doi:10.1016/j.jss.2014.10.028

Cited by 31 publications

(15 citation statements)

References 47 publications

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“…In this investigation, additional evidence is provided by quantifying the increase in liver function per unit of liver volume, and showed that this increase is also present in patients without underlying liver disease. Furthermore, recent studies showed that PVE combined with coiling led to an increased liver hypertrophy and this improvement might strengthen the significance of the present findings.…”

Section: Discussionsupporting

confidence: 86%

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

Meier

Toso

Terraz

et al. 2015

HPB

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Section: Discussionsupporting

confidence: 86%

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

Meier

Toso

Terraz

et al. 2015

HPB

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“…A recent meta-analysis comparing PVE with ligation of the portal vein (PVL) showed comparable preoperative hypertrophic responses and postoperative morbidity [122]. New developments exist of polyvinyl alcohol particles with plugs or coils as embolizing materials, and have resulted in lower recanalization rates, enhanced hypertrophy, and a decreased occurrence of PLF [123].…”

Section: Enlarging Of Future Remnant Liver Volumementioning

confidence: 99%

Liver resection for cancer: New developments in prediction, prevention and management of postresectional liver failure

Mierlo

Schaap

Dejong

et al. 2016

Journal of Hepatology

102

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“…Consequently, in recent literature, a residual volume, the "standardized FLR" (sFLR) of 25-30% has been described as the benchmark in patients with normal liver function 7 and volumes of at least 40% in patients with parenchymal liver disease. 8,9 Three methods to enlarge FLR are possible in this situation before ERH: (1) surgical right-sided portal vein ligation (PVL), 10,11 (2) portal vein embolization (PVE) as an interventional approach used by various centres [12][13][14] and (3) the surgical approach of "associating liver partition with PVL for staged hepatectomy". [15][16][17] However, as hypertrophy following PVE is necessary but highly variable, we retrospectively analyzed data from our patient cohort for differences in those with good hypertrophy (increase to .25% of the sFLR) and those with a less beneficial increase in size of sFLR.…”

Section: Introductionmentioning

confidence: 99%

Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization—the effect of collaterals on embolized liver volume

Zeile¹,

Bakal

Volkmer³

et al. 2016

The British Journal of Radiology

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Objective: The purpose of this retrospective study was to monitor hypertrophy of future liver remnant following portal vein embolization (PVE) before planned extended right hepatectomy. However, because individual responses to PVE are highly variable, our focus was to identify cofactors of successful hypertrophy. Methods: 28 patients with primary or secondary liver tumours, mean age 64.1 6 12.9 years, underwent PVE. Volumetric analysis of hypertrophy before and after PVE (median 39.0 6 15.7 days) was performed. The embolized liver segments were investigated for occurrence of reperfusion of their portal branches. Blood parameters before PVE were additionally investigated. Results: Patients were divided into responders (21/28) and non-responders (7/28) by post-PVE standardized future liver remnant being above or below 25%, respectively. No significant differences between the groups were found regarding biometric and volumetric parameters before PVE. In the entire group after PVE, the mean absolute increase of Segments 2 and 3 was 196.0 6 84.7 cm 3 and the median relative increase was 46.6 6 98.8%. The formation of left to right hepatic portoportal collaterals exhibited a negative correlation to successful hypertrophy (p 5 0.004) as well as low plasma total protein (p 5 0.019). Successful embolization of Segment IV showed only a trend to significance (p 5 0.098). Conclusion: Cofactors associated with a favourable outcome regarding hypertrophy were the absence of collaterals in the control CT scans and high plasma total protein. Advances in knowledge:Portoportal collaterals negatively influence hypertrophy after PVE. On the other hand, plasma total protein is a positive prognostic indicator on hypertrophy of the liver in our cohort.

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Portal vein embolization with plug/coils improves hepatectomy outcome

Cited by 31 publications

References 47 publications

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

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

Liver resection for cancer: New developments in prediction, prevention and management of postresectional liver failure

Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization—the effect of collaterals on embolized liver volume

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