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Preoperative right portal vein embolisation: indications and results

Embolizzazione pre-chirurgica del ramo portale di destra: indicazioni e risultati

  • Vascular and Interventional Radiology/Radiologia Vascolare Ed Interventistica
  • Published:
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Abstract

Purpose

The purpose of this retrospective study was to evaluate the efficacy of right portal vein embolisation (PVE) in inducing contralateral liver hypertrophy before extended hepatectomy.

Materials and methods

Twenty-six consecutive patients, 14 with liver metastases (ten from colorectal cancer; four from carcinoid tumours) and 12 with biliary cancers (ten Klatskin tumours; one gallbladder tumour; one intrahepatic cholangiocarcinoma) with insufficient predicted future remnant liver (FRL) underwent right PVE to induce hypertrophy of the contralateral hemiliver prior to surgical resection. Total liver volume, tumour volume and FRL volume were calculated on a 3D workstation. The ratio of the FRL to the total functional liver volume was <30% in all patients.

Results

The FRL volume increased by 5%–25% (15% on average) after right PVE in patients with liver metastases and by 9%–19% (14% on average) in patients with biliary cancers. In all patients, the ratio of FRL to functional liver volume was ≥30% after right PVE. No postoperative deaths due to severe liver failure occurred in the 20 patients who underwent extended hepatectomy.

Conclusions

Right PVE extends the indications for hepatectomy in patients with liver metastases and those with biliary cancers who have an insufficient potential hepatic functional reserve.

Riassunto

Obiettivo

Lo scopo del nostro studio retrospettivo è stato di valutare l’efficacia dell’embolizzazione del ramo portale destro (RPVE) come trattamento pre-chirurgico per indurre l’ipertrofia del fegato sinistro in pazienti candidati a resezione epatica.

Materiali e metodi

Ventisei pazienti consecutivi, 14 portatori di metastasi epatiche (colon-retto, 10 pazienti; carcinoide, 4 pazienti) e 12 portatori di neoplasia delle vie biliari (neoplasia di Klatskin, 10 pazienti; neoplasia della colecisti, 1 paziente; colangiocarcinoma intraepatico, 1 paziente) con potenziale riserva funzionale epatica (FRL) insufficiente sotto stati sottoposti a RPVE come trattamento pre-chirurgico. Mediante una workstation 3D è stato calcolato il volume epatico totale, il volume del tumore ed il volume del FRL. In tutti i pazienti il rapporto FRL/ volume epatico totale funzionante era <30%.

Risultati

Il volume del FRL ha dimostrato un incremento volumetrico compreso tra il 5%–25% (15% in media) dopo RPVE nei pazienti con metastasi epatiche e tra il 9%–19% (14% in media) in pazienti con neoplasie biliari. In tutti i pazienti il rapporto FRL/volume epatico funzionante dopo RPVE era <30%. Venti pazienti sono stati sottoposti a chirurgia resettiva epatica e nessun paziente è deceduto per insufficienza epatica grave.

Conclusioni

L’embolizzazione portale allarga le indicazioni alla chirurgia resettiva epatica in pazienti con metastasi epatiche e neoplasie delle vie biliari con potenziale riserva funzionale insufficiente.

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References/Bibliografia

  1. 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

    Article  PubMed  CAS  Google Scholar 

  2. Lee KC, Kinoshita H, Hirohashi K et al (1993) Extension of surgical indication for hepatocellular carcinoma by portal vein embolization. World J Surg 17:109–115

    Article  PubMed  CAS  Google Scholar 

  3. Scheele J, Stang R, Altendorf-Hofmann A et al (1995) Resection for liver metastases. World J Surg 19:59–71

    Article  PubMed  CAS  Google Scholar 

  4. Makuuchi M, Thai BL, Takayasu K et al (1990) Preoperative portal vein embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminar report. Surgery 107:521–527

    PubMed  CAS  Google Scholar 

  5. Hashimoto M, Itoh K, Takeda K et al (2008) Evaluation of biliary abnormalities with 64-channel multidetector CT. Radiographics 28:119–134

    Article  PubMed  Google Scholar 

  6. Padhani AR, Ollivier L (2001) The RECIST (Response Evaluation Criteria in Solid Tumors) criteria: implications for diagnostic radiologists. Br J Radiol 74:983–986

    PubMed  CAS  Google Scholar 

  7. Landry CS, Scoggins CR, McMasters KM et al (2008) Management of hepatic metastasis of gastrointestinal carcinoid tumors. J Surg Oncol 97:253–258

    Article  PubMed  Google Scholar 

  8. Barbaro B, Di Stasi C, Nuzzo G et al (2003) Preoperative right portal vein embolization in patients with metastatic liver disease. Metastatic liver volumes after RPVE. Acta Radiol 44:98–102

    Article  PubMed  CAS  Google Scholar 

  9. Clavien PA, Petrowsky H, DeOliveira ML et al (2007) Strategies for safer liver surgery and partial liver transplantation. N Engl J Med 356:1545–1559

    Article  PubMed  Google Scholar 

  10. Iwasaki M, Takada Y, Hayashi M et al (2004) Noninvasive evaluation of graft steatosis in living donor liver transplantation. Transplantation 78:1501–1505

    Article  PubMed  Google Scholar 

  11. Nuzzo G, Giuliante F, Ardito F et al (2008) Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a singlecentre experience. Surgery 143:384–393

    Article  PubMed  Google Scholar 

  12. Nagino M, Kamiya J, Nishio H et al (2006) Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and longterm follow-up. Ann Surg. 243:364–372

    Article  PubMed  Google Scholar 

  13. Abdalla EK, Barnet CC, Doherty D et al (2002) Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 137:675–681

    Article  PubMed  Google Scholar 

  14. Jaeck D, Bachelier P, Guiguet M et al (1997) Long-term survival following resection of colorectal hepatic metastases. Br J Surg 84:977–980

    Article  PubMed  CAS  Google Scholar 

  15. Azoulay D, Castaing D, Smail A et al (2000) Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 231:480–486

    Article  PubMed  CAS  Google Scholar 

  16. Elias D, Ouellet JF, De Baere T et al (2002) Preoperative selective portal vein embolization before hepatectomy for liver metastases: long term results and impact on survival. Surgery 131:294–299

    Article  PubMed  Google Scholar 

  17. Denys AL, Abehserra M, Sauvanet A et al (2000) Intrahepatic hemodynamic changes following portal vein embolization: a prospective doppler study. Eur Radiol 10:1073–1077

    Article  Google Scholar 

  18. Abdalla EK, Hicks ME, Vouthey JN et al (2001) Portal vein embolization: rationale, technique and future prospects. Br J Surg 88:165–175

    Article  PubMed  CAS  Google Scholar 

  19. Nagino M, Nimura Y, Kamiya J et al (1995) Changes in hepatic lobe volume in biliary tract cancer patients after right portal vein embolization. Hepatology 214:434–439

    Google Scholar 

  20. Rous P, Larimore LD(1920) Relation of the portal blood to liver maintenance: a demonstration of liver atrophy conditional on compensation. J Exp Med 31:609–632

    Article  Google Scholar 

  21. Starzl TE, Francavilla A, Halgrimson CG et al (1973) The origin, hormonal nature and action of hepatotrophic substances in portal venous blood. Surg Gynecol Obstet 137:179–199

    PubMed  CAS  Google Scholar 

  22. Yamanaka N, Okamoto E, Kawamura E et al (1993) Dynamics of normal and injured human liver regeneration after hepatectomy as assessed on the basis of computed tomography and liver function. Hepatology 18:79–85

    Article  PubMed  CAS  Google Scholar 

  23. Ribero D, Abdalla EK, Madoff DC et al (2007) Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg 94:1386–1394

    Article  PubMed  CAS  Google Scholar 

  24. Shimamura T, Nakajima Y, Une Y et al (1997) Efficacy and safety of preoperative percutaneous transhepatic portal embolization with absolute ethanol: a clinical study. Surgery 121:135–141

    Article  PubMed  CAS  Google Scholar 

  25. De Baere T, Roche A, Vavasseur D et al (1993) Portal vein embolization: utility for inducing left hepatic lobe hypertrophy before surgery. Radiology 188:73–77

    PubMed  Google Scholar 

  26. Capussotti L, Muratore A, Ferrero A et al (2005) Extension of right portal vein embolization to segment IV portal branches. Arch Surg 140:1100–1103

    Article  PubMed  Google Scholar 

  27. Kubota K, Makuuchi M, Kusaka K et al (1997) Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 26:1176–1181

    PubMed  CAS  Google Scholar 

  28. 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

    Article  PubMed  CAS  Google Scholar 

  29. Kokudo N, Tada K, Seki M (2001) Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology 34:267–272

    Article  PubMed  CAS  Google Scholar 

  30. Selzner N, Pestalozzi BC, Kadry Z et al (2006) Downstaging colorectal liver metastases by concomitant unilateral portal vein ligation and selective intraarterial chemotherapy. Br J Surg 93:587–592

    Article  PubMed  CAS  Google Scholar 

  31. Inaba S, Takada T, Amano H et al (2000) Combination of pre-operative embolization of the right portal vein and hepatic artery prior to major epatectomy in high risk patients: a preliminary report. Hepatogastroenterology 47:1077–1081

    PubMed  CAS  Google Scholar 

  32. Jaeck D, Oussoultzoglou E, Rosso E et al (2004) A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 240:1037–1049

    Article  PubMed  Google Scholar 

  33. Adam R, Delvart V, Pascal G et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240:644–657

    Article  PubMed  Google Scholar 

  34. Kianmanesh R, Farges O, Abdalla EK et al (2003) Right portal vein ligation: a new planned two-step all-surgical approach for complete resection of primary gastrointestinal tumors with multiple bilateral liver metastases. J Am Coll Surg 197:164–170

    Article  PubMed  Google Scholar 

  35. Fusai G, Davidson BR (2003) Management of colorectal liver metastases. Colorectal Dis 5:2–23

    Article  PubMed  CAS  Google Scholar 

  36. Madoff DC, Hicks ME, Abdalla EK et al (2003) 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 227:251–260

    Article  PubMed  Google Scholar 

  37. Fernandez FG, Ritter J, Goodwin JW et al (2005) Effect of steatohepatitis associated with irinotecan or oxaliplatin pretreatment on resectability of hepatic colorectal metastases. J Am Coll Surg 200:845–853

    Article  PubMed  Google Scholar 

  38. Vauthey JN, Pawlik TM, Ribero D et al (2006) Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 24:2065–2072

    Article  PubMed  CAS  Google Scholar 

  39. Rubbia-Brandt L, Audard V, Sartoretti P et al (2004) Severe hepatic sinusoidal obstruction associated with oxaliplatinbased chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 15:460–466

    Article  PubMed  CAS  Google Scholar 

  40. Bilchik AJ, Poston G, Curley SA et al (2006) Neoadjuvant chemotherapy for metastatic colon cancer: a cautionary note. J Clin Oncol 23:9073–9078. Erratum in 24:1648

    Article  Google Scholar 

  41. Farges O, Belghiti J, Kianmanesh R et al (2003) Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 237:208–217

    Article  PubMed  Google Scholar 

  42. Kaneko T, Nakao A, Takagi H (2002) Clinical studies of new material for portal vein embolization: comparison of embolic effect with different agents. Hepatogastroenterology 49:472–477

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Bioimaging and Radiological Sciences, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy

    B. Barbaro, F. Caputo, C. Tebala, C. Di Stasi & L. Bonomo

  2. Department of Surgery, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy

    M. Vellone, F. Giuliante & G. Nuzzo

Authors
  1. B. Barbaro
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  2. F. Caputo
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  3. C. Tebala
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  4. C. Di Stasi
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  5. M. Vellone
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  6. F. Giuliante
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  7. G. Nuzzo
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  8. L. Bonomo
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Correspondence to B. Barbaro.

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Barbaro, B., Caputo, F., Tebala, C. et al. Preoperative right portal vein embolisation: indications and results. Radiol med 114, 553–570 (2009). https://doi.org/10.1007/s11547-009-0383-9

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  • DOI: https://doi.org/10.1007/s11547-009-0383-9

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