Right Portal Vein Embolization Research Articles

Right portal vein ligation is still relevant for left hemi-liver hypertrophy: results of a comparative study using a propensity score between right portal vein ligation and embolization.

In two-stage hepatectomy for bilobar liver metastases from colorectal cancer, future liver remnant (FLR) growth can be achieved using several techniques, such as right portal vein ligation (RPVL) or right portal vein embolization (RPVE). A few heterogeneous studies have compared these two techniques with contradictory results concerning FLR growth. The objective of this study was to compare FLR hypertrophy of the left hemi-liver after RPVL and RPVE. This was a retrospective comparative study using a propensity score of patients who underwent RPVL or RPVE prior to major hepatectomy between January 2010 and December 2020. The endpoints were FLR growth (%) after weighting using the propensity score, which included FLR prior to surgery and the number of chemotherapy cycles. Secondary endpoints were the percentage of patients undergoing simultaneous procedures, the morbidity and mortality, the recourse to other liver hypertrophy procedures, and the number of invasive procedures for the entire oncologic program in intention-to-treat analysis. Fifty-four consecutive patients were retrospectively included and analyzed, 18 in the RPVL group, and 36 in the RPVE group. The demographic characteristics were similar between the groups. After weighting, there was no significant difference between the RPVL and RPVE groups for FLR growth (%), respectively 32.5% [19.3-56.0%] and 34.5% [20.5-47.3%] (p = 0.221). There was no significant difference regarding the secondary outcomes except for the lower number of invasive procedures in RPVL group (median of 2 [2.0, 3.0] in RPVL group and 3 [3.0, 3.0] in RPVE group, p = 0.001)). RPVL and RPVE are both effective to provide required left hemi-liver hypertrophy before right hepatectomy. RPVL should be considered for the simultaneous treatment of liver metastases and the primary tumor.

P-176 Left hemi-liver hypertrophy after right portal vein ligation versus embolization: A comparative study

In two-stage hepatectomy (TSH) for bilobar liver metastases from colorectal cancer, future liver remnant (FLR) growth can be achieved using several techniques like right portal vein ligation (RPVL) and right portal vein embolization (RPVE). Few heterogeneous studies (patients, diagnosis, hepatopathy, technical modalities) have compared these two techniques with contradictory results regarding the FLR growth. The objective of this study was to compare the FLR hypertrophy of left hemi-liver (segments I to IV) after RPVL and RPVE in a serie of consecutives patients all treated for colorectal liver metastases (CLM).

Point-shear wave elastography predicts liver hypertrophy after portal vein embolization and postoperative liver failure.

To correlate point-shear wave elastography (SWE) with liver hypertrophy after right portal vein embolization (RPVE) and to determine its usefulness in predicting postoperative liver failure in patients undergoing partial liver resection. Point-SWE was performed the day before RPVE in 56 patients (41 men) with a median age of 66 years. The percentage (%) of future remnant liver (FRL) volume increase was defined as: %FRLpost-%FRLpre%FRLpre×100 and assessed on computed tomography performed 4 weeks after RPVE. Median (range) %FRLpre and %FRLpost was respectively, 31.5% (12-48%) and 41% (23-61%) (P<0.001), with a median %FRL volume increase of 25.6% (-8; 123%). SWE correlated with %FRL volume increase (P=-0.510; P<0.001). SWV (P=0.003) and %FRLpre (P<0.001) were associated with %FRL volume increase at multivariate regression analysis. Forty-three patients (77%) were operated. Postoperative liver failure occurred in 14 patients (32.5%). Median SWE was different between the group with (1.68m/s) and without liver failure (1.07m/s) (P=0.018). The AUROC of SWE predicting liver failure was 0.724 with a best cut-off of 1.31m/s, corresponding to a sensitivity of 21%, specificity of 96%, positive predictive value 75% and negative predictive value of 72%. SWE was the single independent preoperative variable associated with liver failure. SWE assessed by point-SWE is a simple and useful tool to predict the FRL volume increase and postoperative liver failure in a population of patients with liver tumor.

Volume Regeneration of Segments 2 and 3 After Right Portal Vein Embolization in Patients Undergoing Two-Stage Hepatectomy

BackgroundThe impact of first-stage resection on volume regeneration of segments 2 and 3 (2 + 3) after right portal vein embolization (RPVE) in patients undergoing two-stage right hepatectomy has not been investigated. MethodVolume data for segments 2 + 3 were compared between 44 patients undergoing two-stage hepatectomy and 116 undergoing single-stage hepatectomy after RPVE. ResultsThe degree of hypertrophy (difference between standardized volume of segments 2 + 3 before and after RPVE) and kinetic growth rate (degree of hypertrophy at initial volume assessment divided by the number of weeks elapsed after RPVE) were significantly lower in patients undergoing two-stage hepatectomy (median 8.6 vs 10.5 % [p = 0.01] and 1.7 vs 2.4 % [p < 0.01], respectively). Resection volume during first-stage resection was negatively correlated with standardized volume increase from the volume before first-stage resection (R2 0.546, p < 0.01). In patients undergoing two-stage hepatectomy after RPVE with segment 4 embolization, the degree of hypertrophy and kinetic growth rate were similar to those in patients undergoing single-stage hepatectomy (p = 0.17 and p = 0.08, respectively). ConclusionIn patients undergoing two-stage hepatectomy, first-stage resection impairs the dynamics of volume regeneration of segments 2 + 3 after RPVE. When two-stage extended right hepatectomy is planned, additional embolization of segment 4 provides volume hypertrophy similar to that in patients undergoing single-stage hepatectomy.

Laparoscopic approach to a planned two-stage hepatectomy for bilobar colorectal liver metastases.

This report describes the technical aspects and outcomes of a laparoscopic approach in planned two-stage liver resections for patients with bilobar colorectal cancer (CRC) liver-only metastases. This is a retrospective review of our database examining consecutive patients who underwent an initial first-stage laparoscopic liver resection for CRC metastases, with a planned second-stage resection from 2007 to 2013. Seven patients underwent an initial laparoscopic first stage with concurrent right portal vein ligation (RPVL) in two patients. Median operating time was 100 (60-170) min with a median blood loss of 100 (50-400) mL. Median length of stay was 3 (2-5) days. The remaining five patients required post-operative right portal vein embolization (RPVE). All patients had significant hypertrophy of the future liver remnant (FLR) (future liver remnant volume (FLRV) >25%) and six patients subsequently had a successful open right hepatectomy with one attempted laparoscopically converted to open. Two patients had prolonged bile leaks after the second procedure. Three patients remained disease free, with median follow-up of 34 (13-80) months. One patient had disease progression following RPVE precluding performance of second stage. Laparoscopic first-stage resection of tumours in the left liver can be safely combined with RPVL/RPVE to achieve adequate hypertrophy of the FLR, allowing subsequent right hepatectomy.

2:42 PM Abstract No. 205 - Portal vein embolization for two-stage hepatectomy in patients with colorectal liver metastasis: safety, efficacy, and value of including segment 4

Purpose To examine the efficacy and safety of portal vein embolization (PVE) on future liver remnant (FLR) hypertrophy when used between the first and second stage of two-stage hepatectomy (TSH) in patients with colorectal liver metastases (CLM). Secondary purpose was to evaluate the effect of extending right portal vein embolization (RPVE) to segment 4 (RPVE + 4) on hypertrophy of segments 2 + 3 (S2 + 3). Materials and Methods IRB-approved retrospective cohort study performed from May 1998 to January 2011. Fifty-one patients with CLM underwent PVE as an adjunct to TSH; RPVE was performed in 16 and RPVE + 4 was performed in 35. Absolute FLR volumes, standardized future liver remnant (sFLR) ratios, degree of hypertrophy (DH), and complications were recorded and analyzed with t-tests. To assess the value of extending RPVE to segment 4 in the setting of TSH, absolute volumes and DH were measured for S2 + 3 for all 51 TSH patients. All volumetric measurements were compared to a control cohort composed of 96 patients (n = 37 RPVE, n = 59 RPVE + 4) in whom PVE was performed as an adjunct to single stage hepatectomy (SSH) during the same time period. Results For patients who completed RPVE as an adjunct to TSH (n = 16/16), absolute FLR volume increased from 268.3 mL to 427.3 mL (p Conclusion PVE is an effective and safe technique to induce a significant DH in the FLR prior to definitive stage 2 hepatectomy. Unlike SSH, extending RPVE to RPVE + 4 for TSH does not appear to induce a significant hypertrophy of S2 + 3 volumes.

Usefulness of portography and contrast-enhanced computed tomography to predict the embolized area in percutaneous transhepatic portal vein embolization with absolute ethanol under temporary balloon occlusion

To assess the usefulness of portography and contrast-enhanced computed tomography (CECT) for predicting the embolized area after the first injection of absolute ethanol (AE) in right portal vein embolization (RPVE). Portograms were retrospectively reviewed in 50 patients (30 men and 20 women, mean age 65 years) who had undergone percutaneous transhepatic RPVE with AE under temporary balloon occlusion (TBO) between February 2002 and October 2009. The enhancement pattern before embolization and the embolization pattern after the first AE injection were analyzed by portography. The angles of portal branches against the horizontal plane were measured in 48 patients using pre-treatment CECT. The enhancement pattern was not consistent with the embolization pattern in 35 patients (p < 0.001). When the anterior branch angles were divided into two groups at -5°, 0°, 10°, and 15°, the frequency of the posterior-branch-dominant embolization pattern was higher in the more negatively angled group (p = 0.002-0.041). The distribution of AE is different from that of contrast medium in percutaneous transhepatic RPVE under TBO. The pre-treatment measurement of the angles of portal branches against the horizontal plane on CECT is suggested to be useful for predicting the embolized area.

Preoperative right portal vein embolization in patients with metastatic liver disease: Metastatic liver volumes after RPVE

To quantify liver metastases and future remnant liver (FRL) volumes in patients who underwent right portal vein embolization (RPVE) and to evaluate the effects of this procedure on metastase growth. Nine patients with liver metastases from primary colon (n = 5), rectal lesions (n = 1) and carcinoid tumors (n = 3) underwent spiral CT to evaluate the ratio of the non-tumorous parenchymal volume of the resected liver to that of the whole liver volume (R2). Hand tracing was used to isolate the entire liver, the resected liver and metastase volumes. All patients with R2 > 60% underwent RPVE. FRL exhibited a 101-336 cm3 (average 241 cm3) increase in volume 1 month after RPVE. One patient refused surgery for 2 months and before surgery the increase in volume of the FRL was similar to that of other patients (180.64 cm3). Percent metastases volume from colorectal carcinoma in embolized liver parenchyma increased from 62.4% to 138.4% at 1 month and to 562% at 2 months after RPVE. Metastase volume from carcinoid tumors was unchanged. One month after RPVE, hypertrophy of the FRL is evident. In the embolized liver, there was a progressive increase in metastase volume from colorectal carcinoma while metastase volume from carcinoid tumor was unchanged in embolized and non-embolized liver.

Preoperative Right Portal Vein Embolization in Patients with metastatic liver disease. Metastatic liver volumes after RPVE

Purpose: To quantify liver metastases and future remnant liver (FRL) volumes in patients who underwent right portal vein embolization (RPVE) and to evaluate the effects of this procedure on metastase growth. Material and Methods: Nine patients with liver metastases from primary colon (n = 5), rectal lesions (n = 1) and carcinoid tumors (n = 3) underwent spiral CT to evaluate the ratio of the non-tumorous parenchymal volume of the resected liver to that of the whole liver volume (R2). Hand tracing was used to isolate the entire liver, the resected liver and metastase volumes. All patients with R2 > 60% underwent RPVE. Results: FRL exhibited a 101–336 cm3 (average 241 cm3) increase in volume 1 month after RPVE. One patient refused surgery for 2 months and before surgery the increase in volume of the FRL was similar to that of other patients (180.64 cm3). Percent metastases volume from colorectal carcinoma in embolized liver parenchyma increased from 62.4% to 138.4% at 1 month and to 562% at 2 months after RPVE. Metastase volume from carcinoid tumors was unchanged. Conclusion: One month after RPVE, hypertrophy of the FRL is evident. In the embolized liver, there was a progressive increase in metastase volume from colorectal carcinoma while metastase volume from carcinoid tumor was unchanged in embolized and non-embolized liver.

Changes in hepatic lobar function after right portal vein embolization. An appraisal by biliary indocyanine green excretion.

The changes in the functional capacity of the hepatic lobe after right portal vein embolization (RPE) were investigated in patients with complete obstruction of the hepatic hilus who had undergone multiple percutaneous transhepatic biliary drainage catheterizations. After injection of 0.5 mg/kg of indocyanine green (ICG), bile draining from each hepatic lobe was collected separately for 6 hours. Biliary ICG excretion in each hepatic lobe was estimated and compared with hepatic lobar volume measured by computed tomographic volumetry before and an average of 11 days after RPE. Right portal vein embolization produced a significant increase in bile volume and biliary ICG concentration in the left lobe, resulting in a significant increase in ICG excretion in the left lobe. The percentage of ICG excretion in the left lobe to the whole-liver excretion showed a mean increase of 20.1%, which was statistically significant. In contrast, the percentage of left lobar volume to the total liver volume increased by only 8.3%. Measurement of biliary ICG excretion is useful for estimating changes of hepatic lobar function and has revealed that within 11 days RPE enhances functional capacity in the left lobe compared with volume gain without affecting total liver function.