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Liver Diseases pp 611-616 | Cite as

Portal Vein Embolization (PVE) and Partial TIPE ALPPS: Beyond the Limitations of PVE

  • Yutaka Suzuki
  • Yoshihiro SakamotoEmail author
Chapter

Abstract

Portal vein embolization (PVE) if often used before major hepatectomy to increase the volume of the future liver remnant (FLR) and thus prevent postsurgical liver failure. In this chapter, the history, methods, efficacy, and limitations of PVE are summarized, and a potential breakthrough in the limitations of PVE is described. PVE was introduced in 1982 in the case of a patient with cholangiocarcinoma. Since its introduction, the indications for preoperative PVE have extended to hepatocellular carcinoma, gallbladder carcinoma, and colorectal liver metastasis, and PVE is now considered an indispensable ancillary procedure performed to ensure the safety of major hepatectomy. There are two main PVE techniques, representing two approaches to PVE: transileocolic portal vein embolization (TIPE) and percutaneous transhepatic portal vein embolization (PTPE). Various embolic materials can be used to occlude the portal branches that will be resected.

However, about 20% of patients who undergo PVE cannot undergo subsequent hepatectomy, often because of tumor progression during the waiting period of 3–8 weeks. To resolve problem, a new two-stage hepatectomy procedure, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), has been applied efficaciously mainly in European countries. The advantage of ALPPS is rapid and significant hypertrophy of the FLR, occurring 7–10 days after the first-stage procedure. The disadvantage of ALPPS is the high associated mortality rate (9% in liver metastasis). To overcome this shortcoming, we developed a modified ALPPS procedure, partial TIPE ALPPS, in which partial liver partition and TIPE are performed as the first-stage procedure. We have applied partial TIPE ALPPS in ten patients so far and found no resulting mortality. In addition, we found that partial TIPE ALPPS, in comparison to conventional PVE, increases volume gain of the FLR.

Keywords

Portal vein embolization (PVE) Transileocolic portal vein embolization (TIPE) Percutaneous transhepatic portal vein embolization (PTPE) Two-stage hepatectomy (TSH) Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) Partial TIPE ALPPS 

References

  1. 1.
    Rous P, Larimore LD. Relation of the portal blood to liver maintenance: a demonstration of liver atrophy conditional on compensation. J Exp Med. 1920;31(5):609–32.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Honjo I, Suzuki T, Ozawa K, Takasan H, Kitamura O. Ligation of a branch of the portal vein for carcinoma of the liver. Am J Surg. 1975;130(3):296–302.PubMedCrossRefGoogle Scholar
  3. 3.
    Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunven P, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107(5):521–7.PubMedGoogle Scholar
  4. 4.
    Imamura H, Shimada R, Kubota M, Matsuyama Y, Nakayama A, Miyagawa S, et al. Preoperative portal vein embolization: an adult of 84 patients. Hepatology. 1999;29(4):1099–105.PubMedCrossRefGoogle Scholar
  5. 5.
    Nagino M, Nimura Y, Kamiya J, Kondo S, Kanai M. Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: the ipsilateral approach. Radiology. 1996;200(2):559–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Nagino M, Nimura Y, Kamiya J, Kondo S, Uesaka K, Kin Y, et al. Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma. Surgery. 1995;117(6):677–81.PubMedCrossRefGoogle Scholar
  7. 7.
    Aoki T, Imamura H, Hasegawa K, Matsukura A, Sano K, Sugawara Y, et al. Sequential preoperative arterial and portal venous embolizations in patients with hepatocellular carcinoma. Arch Surg. 2004;139(7):766–74.PubMedCrossRefGoogle Scholar
  8. 8.
    Sato Y, Koyama S, Tsukada K, Hatakeyama K. Acute portal hypertension reflecting shear stress as a trigger of liver regeneration following partial hepatectomy. Surg Today. 1997;27(6):518–26.PubMedCrossRefGoogle Scholar
  9. 9.
    Schoen JM, Wang HH, Minuk GY, Lautt WW. Shear stress-induced nitric oxide release triggers the liver regeneration cascade. Nitric Oxide. 2001;5(5):453–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Maruhashi S, Sakon M, Nagano H, Gotoh K, Hashimoto K, Kubota M, et al. Effect of portal hemodynamics on liver regeneration studied in a novel portohepatic shunt rat model. Surgery. 2004;136(5):1028–37.CrossRefGoogle Scholar
  11. 11.
    Ozawa K, Takasan H, Kitamura O, Mizukami T, Kamano T. Effect of ligation of portal vein on liver mitochondrial metabolism. J Biochem. 1971;70(5):755–64.PubMedCrossRefGoogle Scholar
  12. 12.
    Ozawa K, Yamada T, Honjo I. Role of insulin as a portal factor in mitochondrial metabolism. Ann Surg. 1974;180(5):716–9.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    de Baere T, Roche A, Vavasseur D, Therasse E, Indushekar S, Elias D, et al. Portal vein embolization: utility for including left hepatic lobe hypertrophy before surgery. Radiology. 1993;288(1):73–7.CrossRefGoogle Scholar
  14. 14.
    Nagino M, Nimura Y, Hayakawa N. Percutaneous transhepatic portal embolization using newly devised catheters: preliminary report. World J Surg. 1993;17(4):520–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Shimamura T, Nakajima Y, Une Y, Namieno T, Ogasawara K, Yamashita T, et al. Efficacy and safety of preoperative percutaneous transhepatic portal embolization with absolute ethanol; a clinical study. Surgery. 1997;121(2):135–41.PubMedCrossRefGoogle Scholar
  16. 16.
    Madoff DC, Hicks ME, Abdalla EK, Morris JS, Vauthey JN. Portal vein embolization with polyvinyl alcohol particles and coils in preparation for major liver resection for hepatobiliary malignancy; safety and effectiveness; study in 26 patients. Radiology. 2003;227(1):251–60.PubMedCrossRefGoogle Scholar
  17. 17.
    de Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V. Preoperative portal vein embolization for extension of hepatectomy indications. Hepatology. 1996;24(6):1386–91.PubMedCrossRefGoogle Scholar
  18. 18.
    Yokoyama Y, Nagino M, Nishio H, Ebata T, Igami T, Nimura Y. Recent advances in the treatment of hilar cholangiocarcinoma: portal vein embolization. J Hepatobiliary Pancreat Surg. 2007;14(5):447–54.PubMedCrossRefGoogle Scholar
  19. 19.
    Nagino M, Kamiya J, Nishio H, Ebata T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer. Surgical outcome and long-term follow-up. Ann Surg. 2006;243(3):364–72.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Yamashita S, Sakamoto Y, Yamamoto S, Takemura N, Omichi K, Shinkawa H, et al. Efficacy of preoperative portal vein embolization among patients with hepatocellular carcinoma, biliary tract cancer, and colorectal liver metastasis: a comparative study based on single-center experience of 319 cases. Ann Surg Oncol. 2017;24(6):1557–67.PubMedCrossRefGoogle Scholar
  21. 21.
    Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg. 2002;137(6):675–81.PubMedCrossRefGoogle Scholar
  22. 22.
    Schnizbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size setting. Ann Surg. 2012;255(3):405–14.CrossRefGoogle Scholar
  23. 23.
    Serenari M, Zanello M, Schadde E, Toschi E, Ratti F, Gringeri E, et al. Importance of primary indication and liver function between stages: results of a multicenter Italian audit of ALPPS 2012–2014. HPB. 2016;18(5):419–27.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Sandstrom P, Rosok BI, Sparrelid E, Larsen PN, Larsson AL, Lindell G, et al. ALPPS improves resectability compared with conventional two-stage hepatectomy in patients with advanced colorectal liver metastasis. Results from a Scandinavian multicenter randomized control trial (LIGRO trial). Ann Surg. 2018;267(5):833–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Zhou Z, Mingxing X, Lin N, Pan C, Zhou B, Zhong Y, et al. Associating liver partition and portal vein ligation for staged hepatectomy versus conventional two-stage hepatectomy: a systemic review and meta-analysis. World J Surg Oncol. 2017;15(1):227.  https://doi.org/10.1186/s12957-017-1295-0.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Othubo T, Kobayashi S, Sano K, Misawa T, Ota T, Katagiri S, et al. Safety-related outcomes of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons. J Hepatobiliary Pancreat Sci. 2017;24(5):252–61.CrossRefGoogle Scholar
  27. 27.
    Robles R, Parrilla P, Lopez-Conesa A, Brusadin R, de la Pena J, Fuster M, et al. Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure. Br J Surg. 2014;101(9):1129–34.PubMedCrossRefGoogle Scholar
  28. 28.
    Gall TM, Sodergren MH, Frampton AE, Spalding DR, Habib NA, Pai M. Radio-frequency-assisted liver partition with portal vein ligation (RALPP) for liver regeneration. Ann Surg. 2014;261(2):e45–6.CrossRefGoogle Scholar
  29. 29.
    Sakamoto Y, Inagaki F, Omichi K, Ohkura N, Hasegawa K, Kokudo N. Associating liver partial partition and transileocecal portal vein embolization for staged hepatectomy. Ann Surg. 2016;264(6):e21–2.PubMedCrossRefGoogle Scholar
  30. 30.
    Sakamoto Y, Matsumura M, Yamashita S, Ohkura N, Hasegawa K, Kokudo N. Partial TIPE ALPPS for perihilar cancer. Ann Surg. 2018;267(2):e18–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Hepato-Biliary-Pancreatic Surgery DivisionKyorin University HospitalTokyoJapan

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