Modern Methods of Liver Fragment Vicarious Hypertrophy Stimulation prior to Advanced Resections: Assessment of Efficiency and Ways to Improve the Results

Abstract

Aim. To assess an efficiency of modern methods of vicarious hypertrophy stimulation of the remnant liver after advanced resection and to reduce the risk of postoperative liver failure. Material and Methods. Programmed stimulation of liver vicarious hypertrophy was applied in 119 patients including ligation and transection of portal vein branches in 76 patients (64.8%), endovascular embolization of portal vein branches in 21 patients (17.6%), endovascular embolization of the portal vein combined with chemoembolization of the hepatic artery in 15 patients (12.7%), and split in situ liver resection in 7 patients (5.9%). Volume of remnant liver was measured using computerized tomography, magnetic resonance imaging and/or ultrasound prior to and in 2–4 weeks after occlusion of portal vein branches. Results. According to CT/MRI data remnant liver volume increased from 28.4% to 48.7% (by 38.9 ± 5.5% on the average). 72 patients (60.5%) were operated: right-sided or extended right-sided hemihepatectomies were performed in 49 cases (68%), atypical liver resection – in 21 cases (29.2%). Postoperative complications were registered in 16 cases (22%). Mortality due to post-resection hepatic failure was 2.8%. Liver resection was not performed in 47 cases (39.5%) due to insufficient increase of liver fragment, newly diagnosed intrahepatic metastases or local recurrence of colorectal cancer. Conclusion. Preoperative programmed stimulation of liver fragment is a perspective method that increases percent of operable patients with liver tumors and reduces the risk of hepatic failure after extensive liver resection. Surgical and endovascular methods of preoperative programmed stimulation of liver vicarious hypertrophy are technically feasible and safe.