Abstract
BackgroundRegenerative liver surgery expands the limitations of technical resectability by increasing the future liver remnant (FLR) volume before extended resections in order to avoid posthepatectomy liver failure (PHLF). Portal vein rerouting with ligation of one branch of the portal vein bifurcation (PVL) or embolization (PVE) leads to a moderate liver volume increase over several weeks with a clinical dropout rate of 20–40%, mostly due to tumor progression during the waiting period. Accelerated liver regeneration by the Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) was poised to overcome this limitation by reduction of the waiting time, but failed due increased perioperative complications. Simultaneous portal and hepatic vein embolization (PVE/HVE) is a novel minimal invasive way to induce rapid liver growth without the need of two surgeries.PurposeThis article summarizes published results of PVE/HVE and analyzes what is known about its efficacy to achieve resection, safety, and the volume changes induced.ConclusionsPVE/HVE holds promise to induce accelerated liver regeneration in a similar safety profile to PVE. The demonstrated accelerated hypertrophy may increase resectability. Randomized trials will have to compare PVE/HVE and PVE to determine if PVE/HVE is superior to PVE.
Highlights
Regenerative liver surgery encompasses methods to increase the future liver remnant (FLR) before resection to expand the limitations of technical resectability of liver tumors
In standardized future liver remnant (sFLR), the total liver volume is estimated by biometric data which excludes confounders as tumor volumes or dilated bile ducts and keeps the denominator stable when growth is assessed over multiple scans [6]
This review summarizes the current knowledge about the new method of simultaneous portal and hepatic vein embolization (PVE/HVE), a kind of “turbo”-portal vein embolization (PVE), and investigates its potential as yet another recent innovation in regenerative liver surgery
Summary
Regenerative liver surgery encompasses methods to increase the future liver remnant (FLR) before resection to expand the limitations of technical resectability of liver tumors. N.r not reported, AVP Amplatzer Vascular Plug, CRLM colorectal liver metastasis, HCC hepatocellular carcinoma, IHCC intrahepatic cholangiocarcinoma, MHV middle hepatic vein, NBCA/lipiodol N-butyl-cyanoacrylate and iodized oil, NE: neuroendocrine tumor, PHCC perihilar cholangiocarcinoma, PVE portal vein embolization, PVE/HVE simultaneous portal and hepatic vein embolization, RHV right hepatic vein * Tumor type and information about the embolization were not given in one patient who failed to achieve liver resection + Tumor type of one patient was not given surgery ranges between 21 [27] and 49 days (interquartile range (IQR) 20–210) [26], while one series did not report this time interval at all [30] (Table 2). Seven of 8 series reported on the postoperative complications of this hepatectomy using the Dindo-Clavien classification [15, 25, 26, 28–31], while one comparative study did not provide information about the postoperative outcome according to the Dindo-Clavien classification [27] In these 7 series, 111 patients underwent surgery after PVE/HVE [15, 25, 26, 28–31]. Afterwards, at day 14 and 21, the function does not demonstrate a further increase from baseline (14 days: 57% (SD ± 18) and 21 days: 57% (± 18)
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