Abstract
Background
Postoperative liver failure (PLF) is the most feared and severe complication after extensive liver resections.
Methods
We present an innovative surgical technique that has been employed for the treatment of three patients (two with multiple colorectal liver metastases and one with hilar cholangiocarcinoma) whose livers were previously considered locally unresectable because of an insufficient future liver remnant (FLR). In-situ liver transection with right portal vein ligation was implemented.
Results
Six days after surgery a volumetric computed tomography (CT)-scan showed 40–80% hypertrophy of the FLR. The patients then underwent a completion surgery with right hepatectomy or right trisectionectomy. None of the patients developed PLF during a mean hospital stay of 16 days. After a mean follow-up of two months, the three of them are free of disease.
Conclusions
This technique induced rapid growth of the FLR, greater than that reported with portal vein occlusion alone. It represents a promising advance in oncological liver surgery that readdresses the current management of patients with primarily unresectable liver disease. Such a revolutionary strategy allows a two-stage surgical approach during a single hospital stay and without PLF. However, further research is needed to determine the long-term outcomes of this technique and to explain the occurrence of such enhanced liver regeneration.
References
Agrawal S, Belghiti J (2011) Oncologic resection for malignant tumors of the liver. Ann Surg 253:656–665
Adam R, Laurent A, Azoulay D et al (2000) Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 232:777–785
Liu H, Zhu S (2009) Present status and future perspectives of preoperative portal vein embolization. Am J Surg 197:686–690
Rubbia-Brandt L, Audard V, Sartoretti P et al (2004) Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 15:460–466
Hemming AW, Reed AI, Howard RJ et al (2003) Preoperative portal vein embolization for extended hepatectomy. Ann Surg 237:686–691
Elias D, De Baere T, Roche A et al (1999) During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma. Br J Surg 86:784–788
Kokudo N, Tada K, Seki M et al (2001) Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology 34:267–272
Mueller L, Hillert C, Möller L et al (2008) Major hepatectomy for colorectal metastases: is preoperative portal occlusion an oncological risk factor? Ann Surg Oncol 15:1908–1917
Baumgart J, Lang S, Lang H (2011) A new method for induction of liver hypertrophy prior to right trisectionectomy: a report of three cases. HPB 13(2):1–145
Yokoyama Y, Nagino M, Nimura Y (2007) Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review. World J Surg 31:367–374
Conflict of interest
The authors declare no conflicts of interest associated with the publication of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
de Santibañes, E., Alvarez, F.A. & Ardiles, V. How to Avoid Postoperative Liver Failure: A Novel Method. World J Surg 36, 125–128 (2012). https://doi.org/10.1007/s00268-011-1331-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-011-1331-0