Preoperative right portal vein embolisation: indications and results

Barbaro, Brunella; Caputo, Francesco; Tebala, Carmela; Stasi, Carmine Di; Vellone, Maria; Giuliante, Felice; Nuzzo, Gennaro; Bonomo, Lorenzo

doi:10.1007/s11547-009-0383-9

Cited by 12 publications

(6 citation statements)

References 34 publications

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“…In keeping with this finding, KGR values above 2% have been reported to correlate with favorable surgical outcomes, and the KGR of 4.4±2.0 per week in our study was thus well into the safety zone (28). Thus, EVOH, with a FLRV increase of 52.9% in our study, might be among the most effective agents for inducing liver hypertrophy as compared to the existing literature (Table 5) (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55). One explanation could be the distal and inflammatory nature of EVOH embolization.…”

Section: Discussionsupporting

confidence: 89%

Portal vein embolization with ethylene-vinyl alcohol copolymer for contralateral lobe hypertrophy before liver resection: safety, feasibility and initial experience

Gautier¹,

Chevallier²,

Mastier³

et al. 2021

Quant Imaging Med Surg

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Background: To report our preliminary experience with preoperative portal vein embolization (PVE) using liquid ethylene vinyl alcohol (EVOH) copolymer.Methods: Retrospectively review of patients with primary or secondary liver malignancies scheduled for extensive hepatectomy after the induction of future liver remnant (FLR) hypertrophy by right or left PVE with EVOH as the only embolic agent between 2014 and 2018 at two academic centers. Cross-sectional imaging liver volumetry data obtained before and 3-6 weeks after PVE were used to assess the FLR volume (FLRV) increase, degree of FLR hypertrophy and the FLR kinetic growth rate (KGR).Results: Twenty-six patients (17 males; mean age, 58.7±11 years; range, 32-79 years) were included. The technical and clinical success rate was 100%. PVE produced adequate FLR hypertrophy in all patients.Embolization occurred in all targeted portal branches and in no non-target vessels. The %FLRV increased by 52.9%±32.5% and the degree of FLR hypertrophy was 16.7%±6.8%. The KGR was 4.4%±2.0% per week. Four patients experience minor complications after PVE which resolved with symptomatic treatment.The resection rate was 84.5%. One patient died during surgery for reasons unrelated to PVE.

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Section: Discussionsupporting

confidence: 89%

Portal vein embolization with ethylene-vinyl alcohol copolymer for contralateral lobe hypertrophy before liver resection: safety, feasibility and initial experience

Gautier¹,

Chevallier²,

Mastier³

et al. 2021

Quant Imaging Med Surg

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“…Only 10 studies, including 593 patients, contained all data on total liver volumes, FRL volumes, and the volumes of the embolized lobe before and after PVE [16, 24, 25, 34, 36, 45–49]. From these studies, we could calculate the percentage of atrophy of the embolized liver (EL), using the following equation:…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen articles lacked a detailed description of complications encountered after embolization [9, 11, 12, 16, 24, 31, 40–43, 49–53]. From the other 29 studies (1,179/1,248 patients), the complication rates are summarized in Table 7.…”

Section: Resultsmentioning

confidence: 99%

Portal Vein Embolization Before Liver Resection: A Systematic Review

Lienden

Esschert

Graaf

et al. 2012

Cardiovasc Intervent Radiol

387

337

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PurposeThis is a review of literature on the indications, technique, and outcome of portal vein embolization (PVE).MethodsA systematic literature search on outcome of PVE from 1990 to 2011 was performed in Medline, Cochrane, and Embase databases.ResultsForty-four articles were selected, including 1,791 patients with a mean age of 61 ± 4.1 years. Overall technical success rate was 99.3 %. The mean hypertrophy rate of the FRL after PVE was 37.9 ± 0.1 %. In 70 patients (3.9 %), surgery was not performed because of failure of PVE (clinical success rate 96.1 %). In 51 patients (2.8 %), the hypertrophy response was insufficient to perform liver resection. In the other 17 cases, 12 did not technically succeed (0.7 %) and 7 caused a complication leading to unresectability (0.4 %). In 6.1 %, resection was cancelled because of local tumor progression after PVE. Major complications were seen in 2.5 %, and the mortality rate was 0.1 %. A head-to-head comparison shows a negative effect of liver cirrhosis on hypertrophy response. The use of n-butyl cyanoacrylate seems to have a greater effect on hypertrophy, but the difference with other embolization materials did not reach statistical significance. No difference in regeneration is seen in patients with cholestasis or chemotherapy.ConclusionsPreoperative PVE has a high technical and clinical success rate. Liver cirrhosis has a negative effect on regeneration, but cholestasis and chemotherapy do not seem to have an influence on the hypertrophy response. The use of n-butyl cyanoacrylate may result in a greater hypertrophy response compared with other embolization materials used.

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“…Cirrhotic or diabetic patients have been reported to show the lowest rate of regeneration. 30 In the current study, although patients with higher Ishak stages (>3) tended to have less liver regeneration, including ΔFLRV, ΔFLRV%, and rate of ΔFLRV, this effect was not statistically significant ( 31 This may be because patients enrolled in both studies had well-preserved liver function despite the histological activity index of their chronic hepatitis or due to selection bias of patients. 31 Therefore, the quality (adipose content) of skeletal muscle, instead of quantity of skeletal muscle may play a more important role in liver regeneration when cirrhotic patients with well-preserved liver function, was significant in this study, and patients with both high IMAC and high Ishak fibrosis stage may have a synergistic adverse effect on liver regeneration after PVE.…”

Section: Discussionmentioning

confidence: 54%

Elevated intramuscular adipose tissue content with a high Ishak fibrosis stage (>3) had a negative effect on liver regeneration in cirrhotic patients undergoing portal vein embolization

Huang

Chang

et al. 2022

The Kaohsiung J of Med Scie

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This study investigated the relationship between body composition parameters and changes in future liver remnant volume (FLRV) in hepatocellular carcinoma (HCC) patients undergoing portal vein embolization (PVE) in preparation for right hepatectomy. This retrospective study enrolled 21 patients between May 2013 and October 2020. Body composition parameters, including skeletal muscle attenuation (SMA), skeletal muscle mass index (SMI), intramuscular adipose tissue content (IMAC), and visceral‐to‐subcutaneous adipose tissue area ratio (VSR), were measured by computed tomography (CT) prior to PVE. Liver volumetry was measured before and at least 5 weeks after PVE. The mean interval between two CT volumetries was 9.1 ± 4.9 weeks, the mean value of increase in FLRV (ΔFLRV) was 236.0 ± 118.3 cm3, the ratio of increased FLRV (ΔFLRV%) was 55.7 ± 29.4%, and the rate of increased FLRV was 31.0 ± 18.8 (cm3/week). Subjects with high IMAC showed significantly lower (p = 0.044) ΔFLRV% than those with normal IMAC. Furthermore, ΔFLRV% was linearly reduced (p for trend = 0.043) among those with low Ishak fibrosis stage (<3) + normal IMAC (76.1 ± 36.8%), those with low Ishak fibrosis stage (<3) + high IMAC or high Ishak fibrosis stage (>3) + normal IMAC (54.0 ± 24.1%), and those with high Ishak fibrosis stage (>3) + low IMAC (28.7 ± 1.6%) (p for trend = 0.043). Our data indicated that high IMAC with a high Ishak fibrosis stage (>3) had a significant negative effect on ΔFLRV%.

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Preoperative right portal vein embolisation: indications and results

Abstract: Right PVE extends the indications for hepatectomy in patients with liver metastases and those with biliary cancers who have an insufficient potential hepatic functional reserve.

Cited by 12 publications

References 34 publications

Portal vein embolization with ethylene-vinyl alcohol copolymer for contralateral lobe hypertrophy before liver resection: safety, feasibility and initial experience

Portal vein embolization with ethylene-vinyl alcohol copolymer for contralateral lobe hypertrophy before liver resection: safety, feasibility and initial experience

Portal Vein Embolization Before Liver Resection: A Systematic Review

Elevated intramuscular adipose tissue content with a high Ishak fibrosis stage (>3) had a negative effect on liver regeneration in cirrhotic patients undergoing portal vein embolization

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