Abstract
Objective
The aim of this study was to assess the safety and efficacy of extended liver venous deprivation (eLVD), i.e. combination of right portal vein embolisation and right (accessory right) and middle hepatic vein embolisation before major hepatectomy for future remnant liver (FRL) functional increase.
Methods
eLVD was performed in non-cirrhotic patients referred for major hepatectomy in a context of small FRL (baseline FRL <25% of the total liver volume or FRL function <2.69%/min/m2). All patients underwent 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) and computed tomographic evaluations.
Results
Ten consecutive patients underwent eLVD before surgery for liver metastases (n = 8), Klatskin tumour (n = 1) and gallbladder carcinoma (n = 1). FRL function increased by 64.3% (range = 28.1-107.5%) at day 21. In patients with serial measurements, maximum FRL function was at day 7 (+65.7 ± 16%). The FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day). Thirty-one days (range = 22-45 days) after eLVD, 9/10 patients were resected. No post-hepatectomy liver failure was reported. Two grade II and one grade III complications (Dindo-Clavien classification) occurred. No patient died with-in 90 days following surgery.
Conclusions
eLVD is safe and provides a marked and very rapid increase in liver function, unprecedented for an interventional radiology procedure.
Key Points
• eLVD is safe
• eLVD provides a marked and very rapid increase in liver function
• After eLVD, the FRL-F increased by 64.3% (28.1-107.5%) at day 21
• After eLVD, the maximum FRL-F was obtained at day 7 (+65.7 ± 16%)
• After eLVD, the FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day)
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Abbreviations
- CT:
-
Computed tomography
- PVE:
-
portal vein embolisation
- FRL:
-
future remnant liver
- FRL-V:
-
future remnant liver volume
- FRL-F:
-
future remnant liver function
- HV:
-
hepatic vein
- HVE:
-
hepatic vein embolisation
- ALPPS:
-
associating liver partition and portal vein ligation for staged hepatectomy
- MHV:
-
middle hepatic vein
- PHLF:
-
post-hepatectomy liver failure
- LVD:
-
liver venous deprivation
- eLVD:
-
extended liver venous deprivation
- HBS:
-
hepatobiliary scintigraphy
- AST:
-
aspartate aminotransferase
- ALT:
-
serum alanine aminotransferase
- GGT:
-
gamma-glutamyl-transpeptidase
- ALP:
-
alkaline phosphatase
- PT:
-
prothrombin time
- LDLT:
-
living donor liver transplantation
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Acknowledgements
The authors thank Dr. Hélène de Forges for editing and writing assistance, Dr. Julie Carr for revising the English, Dr. Raphael Tetreau for the CT-scan acquisitions and Prof. Samir Jaber for his helpful assistance.
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The scientific guarantor of this publication is Prof. Boris Guiu.
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Methodology
• retrospective
• observational study
• performed at one institution
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Guiu, B., Quenet, F., Escal, L. et al. Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function. Eur Radiol 27, 3343–3352 (2017). https://doi.org/10.1007/s00330-017-4744-9
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DOI: https://doi.org/10.1007/s00330-017-4744-9