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Improving the Safety of Major Resection for Hepatobiliary Malignancy: Portal Vein Embolization and Recent Innovations in Liver Regeneration Strategies

  • Interventional Oncology (DC Madoff, Section Editor)
  • Published:
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Abstract

Purpose of review

For three decades, portal vein embolization (PVE) has been the “gold-standard” strategy to hypertrophy the anticipated future liver remnant (FLR) in advance of major hepatectomy. During this time, CT volumetry was the most common method to preoperatively assess FLR quality and function and used to determine which patients are appropriate surgical candidates. This review provides the most up-to-date methods for preoperatively assessing the anticipated FLR and summarizes data from the currently available strategies used to induce FLR hypertrophy before surgery for hepatobiliary malignancy.

Recent findings

Functional and physiological imaging is increasingly replacing standard CT volumetry as the method of choice for preoperative FLR assessment. PVE, associating liver partition and portal vein ligation, radiation lobectomy, and liver venous deprivation are all currently available techniques to hypertrophy the FLR. Each strategy has pros and cons based on tumor type, extent of resection, presence or absence of underlying liver disease, age, performance status, complication rates, and other factors.

Summary

Numerous strategies can lead to FLR hypertrophy and improve the safety of major hepatectomy. Which is best has yet to be determined.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA

    David C. Madoff

  2. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Bruno C. Odisio

  3. Department of Surgery, Rush University Medical Center, Chicago, IL, USA

    Erik Schadde

  4. Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland

    Erik Schadde

  5. Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

    Erik Schadde

  6. Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, IL, USA

    Ron C. Gaba

  7. Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Roelof J. Bennink

  8. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Thomas M. van Gulik

  9. Department of Radiology, St-Eloi University Hospital-Montpellier, Montpellier, France

    Boris Guiu

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  1. David C. Madoff
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Correspondence to David C. Madoff.

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David C. Madoff declares that he has no conflict of interest. Bruno C. Odisio declares that he has no conflict of interest. Erik Schadde declares that he has no conflict of interest. Ron C. Gaba has received research funding from Guerbet USA LLC, the United States Department of Defense, and the National Institutes of Health, and also has a service contract with Janssen Research & Development LLC. Roelof J. Bennink declares that he has no conflict of interest. Thomas M. van Gulik declares that he has no conflict of interest. Boris Guiu declares that he has no conflict of interest.

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Madoff, D.C., Odisio, B.C., Schadde, E. et al. Improving the Safety of Major Resection for Hepatobiliary Malignancy: Portal Vein Embolization and Recent Innovations in Liver Regeneration Strategies. Curr Oncol Rep 22, 59 (2020). https://doi.org/10.1007/s11912-020-00922-x

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