Selective Portal Vein Embolization Research Articles

Clinical efficacy and safety of injection of lobaplatin via hepatic artery puncture combined with percutaneous portal venipuncture in the treatment of middle and late primary liver cancer

Objective To explore the clinical efficacy and safety of injecting lobaplatin through hepatic artery puncture combined with percutaneous catheter selective portal vein embolization(SPVCE) in the treatment of primary liver cancer. Methods A total of 118 patients with advanced primary liver cancer admitted to Binzhou Central Hospital of Shandong Province from August 2015 to January 2017 were selected as in the study, and randomly divided into two groups according to the digital table, namely TACE(hepatic carcinoma arterial perfusion chemoembolization)+ SPVCE group and TACE group, with 59 cases in each group.In the TACE+ SPVCE group, injection lobaplatin was administered with gelatin sponge as the drug-borne embolic agent, superselective hepatic artery chemoembolization(TACE) combined with SPVCE was performed, regional embolization was performed for liver cancer, and only TACE was administered in the TACE group.The curative effect and adverse reactions of the two groups were observed and compared. Results The short-term objective(CR+ PR) efficiency of the TACE+ SPVCE group was 74.57%(44/59), which was significantly higher than that of the TACE group [54.23% (32/59)], the difference was statistically significant(χ2=5.323, P=0.021). The differences were statistically significant in the main indicators, such as the decrease of tumor lesion volume, the increase of liver volume without cancer, and the decrease of FAP(all P<0.05). The long-term objective efficiency of the TACE+ SPVCE group was 45.76%(27/59), which was also significantly higher than that of the TACE group[32.2%(19/59)], but the difference was no statistically significant(χ2=2.280, P=0.131). The TACE+ SPVCE group extended the median survival time by 3.5 months compared to the TACE group, there was statistically significant difference in median survival between the two groups(t=3.211, P=0.000). Major adverse reactions were compared between the two groups, the patients with decreased albumin in the TACE + SPVCE group was less than the TACE group, but there was no statistically significant difference(χ2=1.156, P=0.282), the patients with bone marrow inhibition in the TACE + SPVCE group decreased significantly compared with the TACE group, the difference was statistically significant(χ2=4.882, P=0.027), patients with severe gastrointestinal tract decreased compared with conventional TACE group, but there was no statistically significant difference(χ2=1.035, P=0.308). Conclusion Injection for drug carrier with lobaplatin with gelatin sponge embolism agent, percutaneous puncture catheter super choice hepatic artery hepatic artery embolism chemotherapy combined with percutaneous puncture catheter SPVCE for primary liver cancer lines of regional embolization, is safe and effective, and can improve the curative effect of conventional TACE, and prolong survival, has important clinical value for advanced liver cancer patients that cannot be surgically removed. Key words: Liver neoplasms; Percutaneous catheter selective portal vein embolism; Hyperselective hepatic artery chemoembolization; Los platinum; Medicated embolism; Regional embolization of liver cancer; Clinical efficacy; Security

The clinical application value of TACE combined with SPVE in the treatment of two stage hepatectomy

Objective To investigate the clinical application value of liver transarterial chemoembolization (TACE) combined with selective portal vein embolization (SPVE) in the treatment of two stage hepatectomy. Methods From January 2010 to December 2013, 120 patients with liver tumors who were not suitable for one stage hepatectomy admitted to our department were enrolled in this study. Among them, 60 (control group) received TACE therapy and 60(observation group) accepted TACE combined with SPVE treatment. The liver function, liver volume change, the second stage resection, survival rate, complication and adverse reaction were compared between the two groups after treatment, and the application value of the therapy was analyzed. Results All the patients were successfully completed the treatment. The aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TB) of the two groups were all recovered to the pre-treatment level on the 7th day after treatment, and there was no statistical difference between the two groups (P>0.05). Except for the 6th months, the survival rates of the observation group in 12th months, 18 months and 24 months were all higher than those in the control group. The liver volume of the control group and the observation group increased to varying degrees, and the tumor volume showed varying degrees of atrophy. The residual liver volume (RLV) of the observation group was (527.29±58.69)cm3, which was increased and higher than the control group before the treatment (P 0.05). Conclusions The treatment of TACE combined with SPVE can effectively control tumor growth, increase RLV, so as to improve the resection rate and survival rate of patients with primary hepatectomy who can not undergo primary resection. Key words: Liver neoplasms/SU; Hepatectomy; Portal vein/SU; Chemoembolization, therapeutic

Academic contribution of Masatoshi Makuuchi: a master of hepatobiliary surgery, an example to learn from

The famous professor, Masatoshi Makuuchi was known as the king of the liver surgery. Authors concluded main contributions of Masatoshi Makuuchi by reviewing literatures. (1) He was the first to use intraoperative ultrasonography during liver operations. Furthermore, he pioneered anatomical hepatectomy and ultrasound guided transhepatic cholangiography and cholangial drainage. (2) He was the first to adopted pre-operative selective portal vein embolization (PVE) and hemihepatic blood flow occlusion. (3) He performed the first adult-to-adult living donor liver transplantation (A-ALDLT) worldwide and established the well-known formula to predict standard liver volume. (4) The more laudable achievement is promoting these advanced concepts and techniques to the world, training a large group of contemporary hepatobiliary surgeons and benefiting a great number of patients. Masatoshi Makuuchi is a well-deserved master and a good example for contemporary hepatobiliary surgeons to follow. Key words: Hepatobiliary surgery; Masatoshi Makuuchi; Contributions; Learning

Feasibility and safety of EUS-guided selective portal vein embolization with a coil and cyanoacrylate in a live porcine model.

Background and Objectives:Preoperative portal vein (PV) embolization using the percutaneous transhepatic approach has been performed in patients with hepatobiliary malignancy before extensive liver resection. The aim of this study is to evaluate the technical feasibility and initial safety of EUS-guided selective PV embolization using a coil and cyanoacrylate in a live porcine model.Methods:EUS-guided selective intrahepatic PV embolization with a coil and cyanoacrylate was performed in 9 pigs. The selected PV was punctured with 19G fine-needle aspiration (FNA) needle, and the coil was inserted under EUS-guidance. The cyanoacrylate was then immediately injected through the same FNA needle. The blood flow change in the embolized PV was evaluated using color Doppler EUS. A necropsy was performed following the 1-week observation period.Results:The success rates for the coil and cyanoacrylate delivery were 88.9% (8/9) and 87.5% (7/8), respectively. In 1 case, the coil migrated into the hepatic parenchyma. In another case, the cyanoacrylate injection failed due to early clogging in the FNA needle. There was a complete blockage of blood flow confirmed by color Doppler EUS in the embolized PV after coil and cyanoacrylate treatment. There was coil migration into the hepatic parenchyma in 1 case. There was no animal distress observed during the 1-week observation period before necropsy. The necropsy showed no evidence of damage to the intra-abdominal organs, and the selected PV was totally occluded with embolus.Conclusion:The study findings indicate EUS-guided selective PV embolization is both technically feasible and initially safe in an animal model.

Uneven acute non-alcoholic fatty change of the liver after percutaneous transhepatic portal vein embolization in a patient with hilar cholangiocarcinoma \u2013 a case report

BackgroundPortal vein embolization is essential for patients with biliary cancer who undergo extended hepatectomy to induce hypertrophy of the future remnant liver. Over 830 patients have undergone the portal vein embolization at our institution since 1990. Non-alcoholic fatty liver disease is an entity of hepatic disease characterized by fat deposition in hepatocytes. It has a higher prevalence among persons with morbid obesity, type 2 diabetes, and hyperlipidemia. Neither the mechanism of hepatic hypertrophy after portal vein embolization nor the pathophysiology of non-alcoholic fatty liver disease has been fully elucidated. Some researchers integrated the evident insults leading to progression of fatty liver disease into the multiple-hit hypothesis. Among these recognized insults, the change of hemodynamic status of the liver was never mentioned.Case presentationWe present the case of a woman with perihilar cholangiocarcinoma who received endoscopic biliary drainage and presented to our institute for surgical consultation. A left trisectionectomy with caudate lobectomy and extrahepatic bile duct resection was indicated for curative treatment. To safely undergo left trisectionectomy, she underwent selective portal vein embolization of the liver, in which uneven acute fatty change subsequently developed. The undrained left medial sector of the liver with dilated biliary tracts was spared the fatty change. The patient underwent planned surgery without any major complications 6 weeks after the event and has since resumed a normal life. The discrepancies in fatty deposition in the different sectors of the liver were confirmed by pathologic interpretations.ConclusionThis is the first report of acute fatty change of the liver after portal vein embolization. The sparing of the undrained medial sector is unique and extraordinary. The images and pathologic interpretations presented in this report may inspire further research on how the change of hepatic total inflow after portal vein embolization can be one of the insults leading to non-alcoholic fatty liver disease/ change.

Portal vein embolization and ligation induced liver regeneration in rats with hepatic fibrosis

Objective To investigate the portal vein embolization (PVE) and portal vein ligation (PVL) in liver regeneration of rats with hepatic fibrosis . Methods Fifty rats with liver fibrosis were prepared, including 10 rats were randomly chosen as pre-operative control group. The other 40 rats were divided into two groups: PVE group (A1, n=20) and PVL group (A2, n=20). We chose to embolize and ligate the right portal vein, respectively. The blood samples were obtained at different end points for measuring ALT and AST levels. Each liver lobes and whole liver were weighed, and non-embolized liver lobe/whole liver weight ratio, non-ligated liver lobe/whole liver weight were caculated at different end points. The samples from liver with/without embolization or ligation were were stained with hematoxylin-eosin, and the changes of microstructure of liver were observed. Immunostained for PCNA and Ki-67 were performed. Results Transient elevation of postoperative ALT and AST levels were noted in each group. Serum ALT and AST reached the peak on the first day in both of PVE and PVL groups [ALT, A1(66.5±6.3) U/L vs(491.5±48.0) U/L, A2 group(62.8±5.7) U/L vs(433.7±41.0) U/L; AST, A1group (113.4±12.5) U/L vs(685.2±65.7) U/L, A2 group (110.4±11.1) U/L vs(623.9±75.2) U/L, P 0.05). The weight percentage of non-embolized and non-ligated liver lobes/whole liver after PVE and PVL increased. There was no significant difference between the first day and pre-operative levels (P>0.05) . Nevertheless, there were significant differences observed from the third, seventh, fourteenth days (A1 group, 50.2±5.0, 57.7±5.7, 61.8±6.6; A2group, 49.6±3.5, 55.7±6.9, 63.0±5.1, respectively)compared with pre-operative groups (A1 group, 34.4±4.0; A2 group, 34.4±4.0) (P 0.05). The PCNA and Ki-67 were positive in hepatocytes and increased after operation, reached the peak in the third day (P 0.05). Conclusions Fibrosis rats had the ability of regeneration in the contralateral part of the liver after selective PVE and PVL and there was no significant difference on the proliferative degree. Therefore, the safety and reliability of PVE and PVL in inducing liver regeneration in rats with liver fibrosis were confirmed. Key words: Portal vein embolization; Portal vein ligation; Fibrosis; Liver regeneration

The clinical practice of improvement the "Volume and Quality" of functional liver in autologous liver transplantation for the patients with alveolar echinococcosis

Objective: To investigate the clinical significance of accurate assessment of "volume and quality" of functional liver in Autologous liver transplantation (ALT) in the treatment of the advanced hepatic alveolar echinococcosis (HAE). Methods: The clinical data of 12 patients with advanced HAE who underwent ALT at the First Affiliated Hospital of Xinjiang Medical University from May 2015 to July 2016 were retrospectively analyzed. Results: The preoperative hepatic functions of 12 patients were 8 Child-Pugh Grade A, 1 Grade B, and 3 Grade C. Three of the patients had moderate or severe jaundice. Three of the patients calculated functional liver graft volume (GV) and standard liver volume (SLV) ratio (GV/SLV) were <30%. After the protection of liver function, anti-infection, percutaneous transhepatic cholangiography drainage (PTCD), selective portal vein embolization (PVE), and staging liver resection, liver function Child-Pugh grade of 11 patients was raised to A grade, and the other patient was B grade, meanwhile the bilirubin was reduced to 2 times the normal value. The GV/SLV ratios of 3 patients with low GV/SLV ratio had reached 44.4%, 47.2% and 56.2% respectively. In this study, the GV/SLV ratios of the 12 patients were between 73.2% and 40.8% with an average of 55.6%. Operation time was 11.5-20.5 h, with an average of 12.3 h. Anhepatic phase time was 193-375 min with median 253.5 min. The red blood cell suspension was 0-6 U during the operation. The average hospitalization was 10-42 d, with the average 22.7 d. Total hospital costs were 121 600-434 800 Yuan, with the median cost of 174 400 Yuan. One patient died of septic shock a week after surgery. Conclusion: (1)ALT may provide feasibility for the advanced HAE. (2)Accurate assessment of functional liver "volume and quality" appeared as the key points to the ALT. (3)Precise surgery and individualized treatment could improve and protect the functional liver "volume and quality" .

Infusion of CD133+ Bone Marrow–derived Stem Cell After Selective Portal Vein Embolization Enhances Functional Hepatic Reserves After Extended Right Hepatectomy

Lim, Chetana MD; Audollent, Raphaëlle MD; Pocard, Marc MD, PhD; Azoulay, Daniel MD, PhD Author Information

Application of transcatheter arterial chemoembolization combined with selective portal vein embolization in two-stage hepatectomy of hepatocellular carcinoma

Objective To explore the application of transcatheter arterial chemoembolization （TACE） combined with selective portal vein embolization （SPVE ） in two-stage hepatectomy of hepatocellular carcinoma （HCC）.Methods From September 2010 to September 2013,a total of 107 patients with HCC in the right liver lobe who were not suitable for one stage hepatectomy received TACE or TACE combined with SPVE treatment were enrolled.Among them,55 received TACE therapy and 52 accepted TACE combined with SPVE treatment.The technique success rate,complication,adverse reactions,the volume change of each liver lobe and the rate of hepatectomy of HCC were observed.Chi-square test was used for numerical data comparison and Student′s t test for measurement data.Results TACE or TACE combined with SPVE therapy was successfully applied in all the 107 patients,the technique success rate was 100%.During treatment period,no complications such as ectopic embolization, liver function failure,puncture tract bleeding,gastrointestinal bleeding,bile leakage and hepatic abscess were observed.After treatment,the adverse reactions included liver function impairment,pain in hepatic region,fever,nausea and vomiting.Four weeks after the treatment,the volumes of tumor and right liver lobe decreased to certain degree in patients with HCC of both TACE group and TACE combined with SPVE group.The volume of left liver lobe in TACE group had no obvious change,while remarkably increased in TACE combined with SPVE group.The pre-treatment residual liver volume （RLV）of TACE group and TACE combined with SPVE group was （404.0 ± 46.3 ）cm^3 and （393.9 ± 65 .7 ）cm^3 , respectively,and the difference was not statistically significant （t=0.927,P =0.356）.Four weeks after the treatment,RLV was （415.4 ±45.7 ）cm^3 and （567.3 ±88.7 ）cm^3 ,respectively,and the difference was statistically significant （t= -11 .219,P 〈0.05）.Patients were followed up for three to six months,the rates of hepatectomy were 38.2%（21/55）and 86.5 %（45/52）in TACE group and TACE combined with SPVE group,and the difference was statistically significant （χ^2 =26.440,P 〈0.01 ）.Conclusion For patients with HCC not suitable for one stage hepatectomy,the treatment of TACE combined with SPVE before operation could effectively control the growth of the tumor,decrease the volume of tumor,increase RLV,and then increase the rate of two-stage hepatectomy. Key words: Liver neoplasms; Interventional; Embolization; Portal vein; Two-stage hepatectomy

Laparoscopic resection for hepatocellular carcinoma: eastern and western experiences.

Laparoscopic resection for hepatocellular carcinoma: eastern and western experiences.

Small animal magnetic resonance imaging: an efficient tool to assess liver volume and intrahepatic vascular anatomy

BackgroundTo develop a noninvasive technique to assess liver volumetry and intrahepatic portal vein anatomy in a mouse model of liver regeneration. Materials and methodsFifty-two C57BL/6 male mice underwent magnetic resonance imaging (MRI) of the liver using a 4.7 T small animal MRI system after no treatment, 70% partial hepatectomy (PH), or selective portal vein embolization. The protocol consisted of the following sequences: three-dimensional–encoded spoiled gradient-echo sequence (repetition time per echo time 15 per 2.7 ms, flip angle 20°) for volumetry, and two-dimensional–encoded time-of-flight angiography sequence (repetition time per echo time 18 per 6.4 ms, flip angle 80°) for vessel visualization. Liver volume and portal vein segmentation was performed using a dedicated postprocessing software. In animals with portal vein embolization, portography served as reference standard. True liver volume was measured after sacrificing the animals. Measurements were carried out by two independent observers with subsequent analysis by the Cohen κ-test for interobserver agreement. ResultsMRI liver volumetry highly correlated with the true liver volume measurement using a conventional method in both the untreated liver and the liver remnant after 70% PH with a high interobserver correlation coefficient of 0.94 (95% confidence interval, 0.80–0.98 for untreated liver [P < 0.001] and 0.90–0.97 after 70% PH [P < 0.001]). The diagnostic accuracy of magnetic resonance angiography for the occlusion of one branch of the portal vein was 0.95 (95% confidence interval, 0.84–1). The level of agreement between the two observers for the description of intrahepatic vascular anatomy was excellent (Cohen κ value = 0.925). ConclusionsThis protocol may be used for noninvasive liver volumetry and visualization of portal vein anatomy in mice. It will serve the dynamic study of new strategies to enhance liver regeneration in vivo.

Analysis of VEGF and TGF-β1 in time-phased rat liver regeneration

Objective To explored vascular epithelium growth factor (VEGF) and transforming growth factor-β1 (TGF-β1) expression profiles in rat liver regeneration after selective portal vein embolization (SPVE).Methods The SPVE model was constructed by embolization of the left portal vein and regenerative liver tissues were collected in postoperative days 1-9.Fifty of the SD rats were divided into the SPVE group (45 rats) and control group (5 rats).The expressions of VEGF and TGF-β1 in regenerative rat liver tissues were detected with immunohistochemistry and Western blot.The relationship between VEGF/TGF-β1 and time-phased rat liver regeneration was analyzed.Results In the SPVE group compared to the control group,the expression of VEGF increased from post operative day 1 to 5,peaking at day 5.The expression of TGF-β1 increased from post operative day 3 to 7,peaking at day 7.Conclusions The results suggest that after SPVE,VEGF fluctuation may correlate with the start of hepatic regeneration,and TGF-β1 fluctuation may correlate with the termination of hepatic regeneration. Key words: Portal vein embolization; Liver regeneration; Vascular epithelium growth factor; Transforming growth factor-β1

1:30 PM Abstract No. 196 - Baseline left portal vein and left liver lobe size predicts hypertrophy of the left liver lobe after right portal vein embolization

Purpose Postoperative liver failure is a concern for patients who undergo partial hepatectomy for malignant liver lesions. Selective portal vein embolization (PVE) aims to increase the volume of the future liver remnant prior to resection. Hypertrophy of the non-malignant segments of liver following PVE is variable. Our objective was to determine whether baseline portal vein and liver size assessed on computed tomography (CT) can predict the degree of hypertrophy of the liver lobe following PVE. Materials and Methods A retrospective cohort study of adult patients who underwent right PVE prior to partial hepatectomy at a single university hospital was undertaken. Patients who had prior resections, prior embolization, had left portal vein or bilateral selective embolization were excluded. Patients were identified from the liver cancer database and PACS. All patients had a CT scan before and after PVE. The cross-sectional area of the main and left portal veins on pre and post-embolization CT were assessed within 1cm of the bifurcation. Volumetric measurements of the left liver lobe on all pre and post-embolization scans was performed. The left lobe was defined as segments 1, 2, 3, 4a and 4b. Data was analysed by linear regression and is expressed as mean (SD) or as stated. Results Fifty-four patients who met our inclusion criteria underwent first time PVE between 2004 and 2011. Fifty-one (94%) patients had colorectal metastases and the mean age of patients was 61 (10) years. The mean time from baseline CT to PVE was 55 (40.5) days and from PVE to post-embolisation CT was 27 (15.5) days. Baseline left portal vein and left liver lobe size were the only significant predictors of post PVE left liver lobe hypertrophy. Every mm 2 increase in baseline left portal vein diameter predicted a 2 cm 3 increase in post PVE left liver lobe size (B = 2.02) (SE: 0.82, p = 0.017). Conversely every cm 3 increase in baseline left liver lobe size predicted a 0.05% reduction in percent increase of left liver lobe size post PVE (B = −0.05) (SE: 0.02, p = 0.002). Conclusion Baseline left portal vein and left liver lobe size predicts post PVE left lobe size in this small cohort. Our findings require validation in larger cohorts derived from multiple centres.

Infusion of CD133+ Bone Marrow–Derived Stem Cells After Selective Portal Vein Embolization Enhances Functional Hepatic Reserves After Extended Right Hepatectomy

This study was designed to evaluate the clinical outcome of patients undergoing portal vein embolization (PVE) and autologous CD133 bone marrow-derived stem cell (CD133+ BMSC) application before extended right hepatectomy. We have previously shown that portal venous infusion of CD133+ BMSCs substantially increases hepatic proliferation, when compared with PVE alone. : Among 40 consecutive patients with a median follow-up of 28 months (7.4-57.2) scheduled for extended right hepatectomy, we compared a preconditioned group with PVE and CD133+ BMSC cotreatment (PVE+SC group, n = 11) and a group pretreated only with PVE (PVE group, n = 11). Functional and overall outcomes after extended right hepatectomy were evaluated. Patients without presurgical treatment served as controls (n = 18). In preconditioned patients, mean hepatic growth of segments II/III 14 days after PVE in the PVE+SC group was significantly higher (138.66 mL ± 66.29) when compared with that of PVE group patients (62.95 mL ± 40.03; P = 0.004). There were no significant differences among all 3 groups regarding general and oncological characteristics and functional parameters on postoperative day (POD) 7. Lack of hepatic preconditioning, extrahepatic extension of resection, and postoperative complications were of negative prognostic value, using univariate analysis (P < 0.05). In multivariate analysis, freedom from postoperative major complications (P = 0.012), coagulation status on POD 7 (international normalized ratio < 1.4; P = 0.027), and presurgical expansion of the future liver remnant volume (P = 0.048) were positively associated with overall survival. Post hoc analysis revealed a better survival for the PVE+SC group (P = 0.028) compared with the PVE group (P = 0.094) and compared with controls. Promising data from this survival analysis suggest that PVE, together with CD133+ BMSC pretreatment, could positively impact overall outcomes after extended right hepatectomy.

Selective portal vein ligation and embolization induce different tumoral responses in the rat liver

Portal vein ligation (PVL) and portal vein embolization (PVE) are used to enhance liver volume before hepatectomy for colorectal liver metastasis (LM). Impact of such techniques on tumor growth is not well known. This experimental study aimed to assess impact of PVE and PVL on LM growth in a murine model of colorectal LM. Single macroscopic tumor was induced by injection of 0.5 × 10(6) DHD/K12 cells under the liver capsule of BDIX rats at day 0. Multiple microscopic tumors were obtained by intra-portal injection of 1 × 10(6) cells at day 7. At day 8, rats were divided in 3 groups: PVE group (selective 70% PVE), PVL group (selective 70% PVL); control group (sham laparotomy). Rats were sacrificed at day 37 (11 in PVE, 12 in PVL, and 10 rats in control groups). Liver volume and LM volumes were assessed. Nonoccluded liver volume was larger in the PVE and PVL groups vs control group (P < .0001 and P < .0001, respectively) but showed no difference in PVE vs PVL groups (P = .08). LM volume in the occluded liver was smaller in the PVE vs control groups (P = .006) and larger in the PVL vs control groups (P = .001). LM volume in the nonoccluded liver was larger in the PVE and PVL groups vs control group (P = .010 and P = .010, respectively) but showed no difference in PVE vs PVL groups (P= .878). Both PVL and PVE modify tumor growth, especially in nonoccluded lobe. These results could be of clinical importance in humans where both techniques are widely used.

Clinical study of correlation of blood perfusion characteristics in liver cancer by contrast-enhanced ultrasonography and individualized interventional therapy

Objective To identify the blood perfusion characteristics of different kinds of liver cancer and individualize interventional treatment models by color Doppler ultrasound(CDUS) and contrast-enhanced ultrasonography (CEUS). Methods The blood perfusion characteristics of 315 patients with liver cancer comfirmed by pathology were analyzed and classified using CDUS and CEUS. Individual interventional therapy models were selected based on the classification. Therapeutic effects were evaluated by EUS,contrast-enhanced CT(CECT) and DSA simultaneously. Results Liver cancer can be classified by the blood perfusion characteristics from CEUS examination. The individualized interventional treatment models were selected and evaluated according to the characteristics:①Solitary small HCC of diameter ≤3 cm group were treated via percutaneous ethanol injection(PEI),radiofrequency(RF) or percutaneous microwave coagulation therapy(PMCT). Necrosis rates of the lesions were 95.0% - 97.9%, 1 and 3 years survival rates were 98.0% and 87.8% ,respectively. ②Diameter ≤5 cm and lesions ≤3 group were treated with RF or PMCT combined PEI. Necrosis rates of the lesions were 93.7% - 94.8% ,1 and 3 years survival rates were 89.8% and 81.4% ,respectively. ③Diameter ＞5 cm and hypervascular tumor main fed by the hepatic artery group were treated with TACE,PEI combined RF or PMCT. Necrosis rates of the lesions were 71.4% - 73.8%, 1 and 3 years survival rates were 66.2% and 47.6%, respectively. ④ Diameter ＞5 cm and hypervascular tumor fed by double blood supply or accompanied by portal vein tumor thrombus group were treated with selective portal vein embolization(SPVE) based on the above treatments. Necrosis rates of the lesions were 53.3% - 55.6%, 1 and 3 years survival rates were 64.7% and 40.0%, respectively. Conclusions Classifying the blood perfusion characteristics and choosing individualized interventional treatment models by CEUS are of important clinical significance in non-surgical treatment of liver cancer. Key words: Ultrasonography; Microbubbles; Liver neoplasms; Antineoplastic protocols

A Rabbit Model for Selective Portal Vein Embolization

Portal vein embolization (PVE) is a technique to increase future remnant liver volume. A standardized animal model, resembling the clinical PVE procedure, is needed to clarify some of the unresolved issues surrounding PVE. For this purpose we developed a new rabbit model for PVE. Twenty female New Zealand white rabbits were allocated to two protocols, each containing two subgroups. Eighty percent of the liver portal venous system was embolized with polyvinyl-alcohol particles and coils (protocol 1: 300-500 μm particles and one coil; protocol 2: 90-180 μm combined 300-500 μm particles and three coils). In all rabbits CT-volumetry, ICG clearance test, blood sampling, and portography were performed prior to PVEand atd 7 and 14. Additional blood sampling and CT volumetry was done on d 3 and 7. PVE was technically feasible in the rabbit. CT-volumetry demonstrated a strong correlation with actual liver weight and volume measured at sacrifice. The hypertrophy response was highest at d 7 in both protocols, which was consistent with the amount of proliferating hepatocytes. Protocol 2 showed less revascularization of the portal venous system and demonstrated the highest hypertrophy response. Comparable to the clinical situation, only a small, transient increase in transaminases was observed. There were no changes in liver function parameters after PVE. Histopathologic findings in the rabbit livers were comparable to those found in human livers. We successfully devised a rabbit model for PVE, which resembles the human clinical situation.

Experimental study of selective portal vein embolization with the mixture of ZT glue and lipiodol

Objective To evaluate the feasibility of Selective Portal Vein Embolization(SPVE)in rabbits with the mixture of ZT glue and Lipiodol.Methods Sixteen white New Zealand rabbits were randomly divided into 2 groups:Group A,ZT glue:Lipiodol(1:2)mixture and Group B Lipiodol group.SPVE of left branch was performed in each group under digital subtraction angiography.The distribution feature of the embolic agents and the histopathology of liver in each group were observed.The weight ratio of the right lobe to the whole liver at the 30th day after SPVE were recorded and analyzed.Results Permanent embolization were occurred in group A.Recanalization was appeared in group B.Atrophy of the embolized lobes and compensatory hypertrophy of none-embolized lohes was,observed..The weight ratio of the right lobe to the whole liver Was 69.41±5.10% in group A.There was statistical difference between these two groups(P＜0.05).Conclusion There were permanent embolization after SPVE with the mixture of ZT glue and lipiodol.SPVE induced atrophy of the embolized lobes of liver and compensatory hypertrophy of none-embolized lobes. Key words: Tissue adhesives/AD; Iodized oil/AD; Embolization,therapeutic; Portal vein

Selective portal vein embolization and ligation trigger different regenerative responses in the rat liver

Two strategies are clinically available to induce selective hypertrophy of the liver: portal vein embolization (PVE) and portal vein ligation (PVL). The aim of this study was to compare the impact of PVE and PVL on liver regeneration. Rats were subjected to 70% PVL, 70% PVE, 70% partial hepatectomy (PH) (positive control), or sham operation (negative control). PVL and PVE of liver segments were validated by portography and histology, demonstrating obstruction of the involved portal branches. Liver weight and markers of regeneration were assessed at 24, 48, and 72 hours, and 7 days after surgery (n = 5). Sinusoidal perfusion was examined by intravital microscopy. The weight of the regenerating liver segments increased continuously in all groups, with the highest weight gain after PH, which also disclosed the strongest proliferative activity. In Ki-67 and PCNA stainings, hepatocyte proliferation after PVL was more pronounced than after PVE (P = 0.01). Volumetric blood flow and functional sinusoidal density were lower after PVE than after PVL (P = 0.006, P = 0.02, respectively). The accumulation of Kupffer cells 24 hours after the intervention was highest after PH. Transcript levels of cytokines (interleukin-1beta, tumor necrosis factor-alpha, interleukin-6) peaked at 24 hours and were highest after PH. The embolized part of the liver after PVE showed prominent foreign body reaction in the portal triad with accumulation of macrophages. PVL is superior to PVE in inducing a regenerative response of the remnant liver. The impairment of liver regeneration after PVE may be a consequence of macrophage trapping in the occluded segment due to a foreign body reaction. Lower blood flow and lower accumulation of macrophages, particularly Kupffer cells, in the regenerating part of the liver likewise causes impaired liver regeneration after PVE.

Chirurgie der Leber: Grenzen des Machbaren

Bilobar hepatic metastases, a small residual liver volume, de-novo and recurrent lesions, simultaneous pulmonary metastases and infiltration of vascular structures are often limiting factors in the surgical treatment of primary and secondary liver tumors. Nevertheless surgery is the "gold standard" with the chance of long-term survival, not possible to achieve with locally ablation and chemotherapy. The combination with neoadjuvant chemotherapy and radiofrequency ablation, extended liver resection after selective portal vein embolization, two-stage hepatectomy, resection and reconstruction of vascular structures in deep hypothermia and simultaneous resection of pulmonary metastases, increase the resectability even in patients with poor prognosis achieving 5-year-survival rates between 26-46 % in colorectal liver metastases, 40 % in primary liver tumors and a median survival of 42 months after resection of liver and lung metastases. Interdisciplinary treatment and aggressive surgical resection seem to be justified, when performed safely as a curative option.