Portal Vein Ligation as an Efficient Method of Increasing the Future Liver Remnant Volume in the Surgical Treatment of Colorectal Metastases

Capussotti, Lorenzo; Muratore, Andrea; F, Baracchi; Lelong, Bernard; Ferrero, Alessandro; Regge, Daniele; Delpero, Jean‐Robert

doi:10.1001/archsurg.143.10.978

Cited by 148 publications

(102 citation statements)

References 25 publications

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“…5 The current systematic review showed hypertrophy of 26-47% at time intervals of from 44 days to 9 months after unilobar SIRT with Y90. Thus while the degree of growth achieved is comparable to that achieved with PVE alone, and superior to that achieved after PVE + TACE, the kinetics of hypertrophy after SIRT are likely to be different from PVE.…”

Section: Other Findingsmentioning

confidence: 55%

A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90

Teo

Allen

et al. 2015

HPB

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Section: Other Findingsmentioning

confidence: 55%

A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90

Teo

Allen

et al. 2015

HPB

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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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“…One very important limiting factor for performing major liver resections is the remaining liver volume, referred to as future liver remnant. Postoperative liver failure consequent to insufficiency of remnant liver is a feared complication in patients who underwent extensive liver resections 2,7 . The estimated future liver remnant volume to prevent postoperative liver failure should be at least 25% of total liver volume in healthy livers.…”

Section: Introductionmentioning

confidence: 99%

“…The estimated future liver remnant volume to prevent postoperative liver failure should be at least 25% of total liver volume in healthy livers. For patients with hepatic dysfunction or earlier liver injury due to chemotherapy, a higher future liver remnant (approximately 40%) is recommended 2,7 . Some strategies have been developed to increase resectability in patients undergoing major hepatic resection.…”

Section: Introductionmentioning

confidence: 99%

Ligadura da veia porta associada à transecção para hepatectomia em dois estágios (ALPPS): uma nova abordagem nas ressecções hepáticas

Torres¹,

Moraes-Junior²,

Lima³

et al. 2012

ABCD, arq. bras. cir. dig.

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-Background -Postoperative liver failure consequent to insufficiency of remnant liver is a feared complication in patients who underwent extensive liver resections. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a new approach for patient which tumor is previously considered unresectable.Aim -To present ALPPS as an innovative surgical technique of two-staged hepatectomy for the treatment of patients with marginally resectable or initially nonresectable primary and metastatic liver tumors. Technique -The procedure is performed in two steps. The first consists on ligation of the right portal vein branch. Subsequently, total or nearly total parenchyma dissection along the falciform ligament is performed, including the middle hepatic vein. A plastic bag is used to cover the right extended lobe, and the abdomen is drained and closed. The second one is performed after a computer tomography, six to 12 days interval. After laparotomy, the plastic bag is removed. The right artery, right bile duct and the right hepatic vein are divided. The extended right lobe is removed. Drain is placed at the resection surface, and the abdomen is closed. Conclusion -The associating of liver partition and portal vein ligation can enable curative resection of liver metastasis in patients with lesions previously considered unresectable. ABCDDV/886RESUMO -Racional -Insuficiência hepática pós-operatória devido a remanescente hepático pequeno tem sido complicação temida em pacientes que são submetidos à ressecção hepática extensa. A associação da transecção hepática e ligadura da veia porta para hepatectomia estagiada (ALPPS) é uma nova abordagem para pacientes em que o tumor é previamente considerado irressecável. Objetivo -Apresentar a técnica ALPPS como procedimento novo de hepatectomia em dois estágios com ligadura da veia porta e transecção hepática mantendo o fígado in situ para o tratamento de pacientes com tumores primários ou metastáticos marginalmente ressecáveis. Técnica -O procedimento é realizado em dois tempos. O primeiro consiste na ligadura do ramo direito da veia porta. Em seguida é realizada a transecção total ou quase total do parênquima hepático acompanhando o ligamento falciforme, incluindo a veia hepática média. Um saco plástico é utilizado para recobrir o fígado que será retirado; o abdome é drenado e realizada a síntese da parede por planos. O segundo tempo é feito após seis a 12 dias de intervalo com realização de tomografia computadorizada de abdome. Na laparotomia o saco plástico é removido. Os ramos direito da artéria hepática, ducto hepático e veia hepática são ligados e o lobo hepático direito é removido. Um dreno é posicionado na superfície de ressecção e a síntese da parede abdominal é realizada. Conclusão -ALPPS permite ressecção curativa de lesões hepáticas em pacientes com doença considerada previamente irressecável.

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Portal Vein Ligation as an Efficient Method of Increasing the Future Liver Remnant Volume in the Surgical Treatment of Colorectal Metastases

Cited by 148 publications

References 25 publications

A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90

A systematic review of contralateral liver lobe hypertrophy after unilobar selective internal radiation therapy with Y90

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

Ligadura da veia porta associada à transecção para hepatectomia em dois estágios (ALPPS): uma nova abordagem nas ressecções hepáticas

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