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Laparoscopic portal branch ligation of the right caudate lobe concomitant with portal vein embolization for planned right hemihepatectomy in advanced hepatobiliary cancers

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Abstract

Background

The role of ligation of the portal venous branches to the caudate lobe (cPVL) as preparation for planned major hepatectomy is unclear. The aim of this study was to evaluate the efficacy of laparoscopic cPVL (Lap-cPVL) concomitant with transileocolic portal vein embolization of the right portal venous system (rTIPE), namely, Lap-cPVL/rTIPE, for planned right hemihepatectomy (rHx) in advanced hepatobiliary cancer patients.

Methods

Thirty-one patients who underwent rHx after rTIPE with/without Lap-cPVL between March 2013 and March 2020 were enrolled in this study. The Lap-cPVL was performed for the portal branches of the right caudate lobe.

Results

Eight of the 31 patients underwent Lap-cPVL/rTIPE. The degree of hypertrophy was significantly increased in Lap-cPVL/rTIPE (19.3%, range 6.5–25.6%) as compared to rTIPE (7.2%, range - 1.1 to 21.2%) (p=0.027). The functional kinetic growth rate was also significantly increased in Lap-cPVL/rTIPE (5.40%, range 2.17–5.97) than that in rTIPE (1.85%, range - 0.22 to 6.45%) (p=0.046). Postoperative liver failure ≧ grade B occurred in 21.7% of patients in rTIPE, while there was no postoperative liver failure ≧ grade B in Lap-cPVL/rTIPE. Mortality rates were zero after rHx in this study.

Conclusions

Lap-cPVL/rTIPE is safe and provides an additional effect on liver hypertrophy in advanced hepatobiliary cancers.

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Authors and Affiliations

  1. Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan

    Yasunari Kawabata, Hikota Hayashi, Kosuke Nakamura, Takashi Kishi, Takeshi Nishi & Yoshitsugu Tajima

  2. Department of Radiology, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane, 693-8501, Japan

    Rika Yoshida, Shinji Ando & Megumi Nakamura

Authors
  1. Yasunari Kawabata
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  2. Hikota Hayashi
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  3. Rika Yoshida
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  4. Shinji Ando
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  5. Kosuke Nakamura
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  6. Takashi Kishi
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  7. Takeshi Nishi
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  8. Megumi Nakamura
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  9. Yoshitsugu Tajima
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Contributions

Study conception and design: Kawabata Y; acquisition of data: Kawabata Y, Hayashi H, Yoshida R, Ando S, Nakamura K, Kishi T, Nishi T, Nakamura M; analysis and interpretation of data: Kawabata Y, Hayashi H, and Nishi T; drafting of the manuscript: Kawabata Y; critical revision: Kawabata Y and Tajima Y; final approval of the article: Kawabata Y, Hayashi H, Yoshida R, Ando S, Nakamura K, Kishi T, Nishi T, Nakamura M, and Tajima Y.

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Correspondence to Yasunari Kawabata.

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Kawabata, Y., Hayashi, H., Yoshida, R. et al. Laparoscopic portal branch ligation of the right caudate lobe concomitant with portal vein embolization for planned right hemihepatectomy in advanced hepatobiliary cancers. Langenbecks Arch Surg 406, 917–926 (2021). https://doi.org/10.1007/s00423-021-02147-3

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