• Chemotherapy
• Combination therapy
• Conversion treatment
• Downstaging
• Immunotherapy
• Intrahepatic cholangiocarcinoma
• Locoregional therapies

• Humans
• Cholangiocarcinoma/therapy
• Cholangiocarcinoma/mortality
• Cholangiocarcinoma/pathology
• Bile Duct Neoplasms/therapy
• Bile Duct Neoplasms/pathology
• Bile Duct Neoplasms/mortality
• Neoplasm Staging
• Treatment Outcome
• Neoplasm Recurrence, Local/prevention & control
• Neoplasm Recurrence, Local/epidemiology
• Hepatectomy/adverse effects
• Disease Progression
• Chemoembolization, Therapeutic/methods
• Neoadjuvant Therapy/methods
• Combined Modality Therapy

• Chemotherapy
• Colorectal liver metastasis
• Conversion therapy
• Gastric liver metastasis
• Molecular-targeted therapy
• Neuroendocrine liver metastasis
• Resection
• Two-stage hepatectomy

• Humans
• Liver Neoplasms/secondary
• Liver Neoplasms/therapy
• Hepatectomy/methods
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/therapy
• Molecular Targeted Therapy
• Combined Modality Therapy

• cholangiocarcinoma
• hepatectomy
• bile duct neoplasms
• embolization, therapeutic
• hypertrophy

• Humans
• Cholangiocarcinoma/surgery
• Cholangiocarcinoma/diagnostic imaging
• Embolization, Therapeutic/methods
• Portal Vein/surgery
• Portal Vein/diagnostic imaging
• Bile Duct Neoplasms/surgery
• Bile Duct Neoplasms/diagnostic imaging
• Hepatic Veins/diagnostic imaging
• Hepatic Veins/surgery
• Hepatectomy/methods
• Male
• Treatment Outcome
• Middle Aged

• Double-vein embolization (DVE)
• Future liver remnant (FLR)
• Hepatic vein embolization (HVE)
• Liver venous deprivation (LVD)
• Portal vein embolization (PVE)
• Post-hepatectomy liver failure (PHLF)

• Humans
• Portal Vein/diagnostic imaging
• Embolization, Therapeutic/methods
• Hepatic Veins/diagnostic imaging
• Liver Regeneration
• Hepatectomy/methods
• Radiography, Interventional
• Liver/blood supply
• Liver/diagnostic imaging

• Unidade Local de Saúde de São José

• hepatic vein embolization
• hepatocellular carcinoma
• liver hypertrophy
• liver resection
• liver venous deprivation
• portal vein embolization

• research received no external funding

• future liver remnant
• hepatic vein deprivation
• liver functional reserve
• liver hypertrophy
• portal vein embolization

• functional liver assessment
• hepatic vein embolization
• resection limit
• right-sided major hepatectomy
• surgical outcome

• Hepatic vein embolization
• Liver venous deprivation
• Portal vein embolization
• Portal vein embolization failure
• Rescue associating liver partition and portal vein ligation
• Segment 4 portal vein embolization

• Embolization, Therapeutic/methods
• Hepatectomy/adverse effects
• Humans
• Liver/surgery
• Portal Vein/pathology
• Treatment Outcome

• Extended hepatectomy
• Future liver remnant (FLR)
• Liver venous deprivation (LVD)
• Portal vein embolization (PVE)
• Right hepatic vein embolization (rHVE)

• Colorectal Neoplasms/pathology
• Embolization, Therapeutic/methods
• Hepatectomy/methods
• Hepatic Veins/pathology
• Humans
• Hypertrophy/pathology
• Hypertrophy/surgery
• Liver/diagnostic imaging
• Liver/pathology
• Liver/surgery
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Matched-Pair Analysis
• Portal Vein/pathology
• Prospective Studies
• Retrospective Studies
• Treatment Outcome

• Charité - Universitätsmedizin Berlin (3093)

• China
• Hepatocellular carcinoma (HCC)
• consensus
• conversion therapy
• locoregional treatment
• surgical resection
• systematic treatment

• Future liver remnant
• Liver resection
• Small-for-size syndrome

Obtaining tumor-free resection margins is one of the most important factors for achieving favorable prognosis of patients undergoing resection for hepatobiliary malignancies. In this study, we present our experience of portal vein (PV) wedge resection and patch venoplasty using autologous or homologous vessel grafts for resecting perihilar cholangiocarcinoma, hepatocellular carcinoma, and distal bile duct cancer. Case 1 was 68-year-old male patient with type IV perihilar cholangiocarcinoma who underwent central bisectionectomy with caudate lobectomy and bile duct resection, and PV wedge resection and patch venoplasty with a cryopreserved iliac vein allograft patch. This patient survived 14 months after surgery. Case 2 was 77-year-old male patient with type IIIA perihilar cholangiocarcinoma who underwent left medial sectionectomy with caudate lobectomy, bile duct resection, and PV wedge resection and patch venoplasty with a cryopreserved iliac vein allograft patch. This patient survived 17 months after surgery. Case 3 was 54-year-old male patient with hepatitis B virus-associated liver cirrhosis and hepatocellular carcinoma with PV tumor thrombus who underwent left hepatectomy. The PV wall defect was repaired with an autologous greater saphenous vein patch. This patient survived 11 months after surgery. Case 4 was 65-year-old female patient with distal bile duct cancer who underwent pylorus-preserving pancreaticoduodenectomy, and main PV wedge resection and patch venoplasty with a cryopreserved iliac artery allograft patch. This patient survived 21 months after surgery. In conclusion, PV wedge resection and patch venoplasty can be used to facilitate complete tumor resection in patients undergoing various extents of surgical resection for hepatobiliary malignancies.

• Allograft
• Autografts
• Greater saphenous vein
• Portal vein
• Vascular reconstruction

It has been reported that parenchyma-preserving hepatectomy (PPH) might lower surgical curability with an increased likelihood of bile duct resection margins (BDRMs). Apparently, PPH is indicated for patients expected to achieve curative resection. The author herein presents a case of a 77-year-old male patient with type IV perihilar cholangiocarcinoma and decreased cardiac function treated with hepatic segments I + IV resection and bile duct resection. During the operation, he underwent two hepatic parenchymal transections matched with right trisectionectomy and left hepatectomy. After removing segments VI and I and extrahepatic bile duct, six hepatic duct openings were exposed at the left and right hila. As some of them were conjoined, two hepaticojejunostomies at the right liver and one hepaticojejunostomy at the left lateral section were performed consecutively. This operation took 7 hours. Eight sessions of intraoperative frozen-section biopsy were performed. All BDRMs were tumor-negative. According to the 8th edition of the American Joint Committee on Cancer staging system, the extent of the tumor was pT2bN2M0. It was regarded as stage IVA tumor. The patient recovered uneventfully. He was discharged on the 18th postoperative day. The patient underwent concurrent chemoradiation therapy and adjuvant chemotherapy. The patient has been doing well without tumor recurrence for the past 24 months to date. In conclusion, PPH can lead to curative resection and improved outcomes through reasonable adjustment of the extent of hepatectomy.

• Bile duct resection margin
• Hepatic failure
• Klatskin tumor
• Parenchyma-preserving hepatectomy
• Perihilar cholangiocarcinoma

• Cirrhosis
• Hepatectomy
• Hepatocellular carcinoma
• Liver transplantation
• Recurrence
• Survival

• Liver resection
• future remnant liver (FRL)
• hypertrophy
• liver failure
• liver function
• liver volume

Primary liver cancer has an insidious onset and no specific symptoms at early stage. Most patients are in the middle or advanced stage when diagnosed, and only 20%-40% of patients meet the criteria for radical resection. At present, surgical resection is still the main radical treatment for primary liver cancer, but factors such as liver function decompensation, too large tumor volume, too small future liver remnant, intrahepatic multiple metastasis, tumor thrombus invading the large vessels or bile duct, and distant metastasis limit the application of surgical resection or liver transplantation. In recent years, with the advances of basic research of primary liver cancer, the development of surgical techniques and equipment, as well as the development of new molecular targeted drugs and immunotherapy drugs, a part of unresectable patients with primary liver cancer can receive conversion therapy to improve liver function, minimize tumor volume, minimize or inactivate tumor thrombus, and increase the residual liver volume. Following conversion therapy, patients with primary liver cancer can undergo surgical resection or liver transplantation, which greatly improve the therapeutic efficacy and patient survival.

• Primary liver cancer
• Conversion therapy
• Indication
• Strategy

Portal venous embolization (PVE) is a minimal invasive preoperative strategy that aims to increase future liver remnant (FLR) in order to facilitate extended hemihepatectomy. We analyzed our data retrospectively regarding complications and degree of hypertrophy (DH).

Methods: 88 patients received PVE either by particles / coils (n = 77) or by glue / oil (n = 11), supported by 7 right hepatic vein embolizations (HVE) by coils or occluders. All complications were categorized by the Clavien- Dindo (CD) and the CIRSE classification.

In 88 patients (median age 68 years) there was one intervention with a biliary leak and subsequent drainage (complication grade 3 CD, CIRSE 3), two with prolonged hospital stay (grade 2 CD, grade 3 CIRSE) and 13 complications grade 1 CD, but no complications of grade 4 or higher neither in Clavien- Dindo nor in CIRSE classification. The median relative increase in FLR was 47% (SD 35%). The mean pre-intervention standardized FLR rose from 23% (SD 10%) to a post-intervention standardized FLR of 32% (SD 12%). The degree of hypertrophy (DH) was 9,3% (SD 5,2%) and the kinetic growth rate (KGR) per week was 2,06 (SD 1,84).

PVE and, if necessary, additional sequential HVE were safe procedures with a low rate of complications and facilitated sufficient preoperative hypertrophy of the future liver remnant.

• FLR
• Hypertrophy
• PVE
• Portal vein embolization
• Portal vein occlusion

• Bile duct resection margin
• Hepatic failure
• Klatskin tumor
• Parenchyma-preserving hepatectomy
• Perihilar cholangiocarcinoma

• colorectal liver metastasis
• future liver remnant
• liver venous deprivation (LVD)
• oncological outcomes

• Chemotherapy
• Colorectal liver metastasis
• Conversion therapy
• Gastric liver metastasis
• Molecular-targeted therapy
• Neuroendocrine liver metastasis
• Resection
• Two-stage hepatectomy

• Colorectal Neoplasms/pathology
• Hepatectomy
• Humans
• Liver Neoplasms/drug therapy
• Liver Neoplasms/pathology
• Neoplasm Staging
• Prognosis

• P30 CA016672 NCI NIH HHS
• T32 CA009599 NCI NIH HHS

• future liver remnant
• hepatectomy
• portal vein embolization

We present two cases of hepatic atrophy treatment with portal vein embolization (PVE) to control intractable cholangitis. The first case was a 60-year-old male who was admitted for repeated episodes of cholangitis. He had undergone cholecystectomy and Roux-en-Y choledochojejunostomy 2 years earlier. Imaging studies showed left intrahepatic duct dilatation and anastomotic site stricture. The patient was reluctant to undergo another surgery. Thus, we decided to perform left PVE to induce atrophy of the left liver. The left liver shrank and stayed silent for 5 years, but a radiological intervention was necessary to treat symptomatic anastomotic stenosis. The patient has done well for 12 years after PVE. The second case was a 51-year-old female who was also admitted for repeated episodes of cholangitis. She had undergone excision of type I choledochal cyst 2 years earlier. Imaging studies showed right hepatic duct stenosis. Cholangitis developed repeatedly. Thus, radiologic interventions were performed 8 times over 9 years. Finally, she was referred for surgery, but she was very reluctant to undergo another surgery. We planned a wait-and-see strategy following right PVE. After PVE, the right liver progressively shrank. Three months after PVE, we decided to wait for a longer period until further atrophy of the right liver. The patient has been doing well for 14 months after PVE without any episode of cholangitis. In conclusion, experience from our two cases suggests that hepatic parenchymal induction therapy through percutaneous PVE can be a therapeutic option for patients with perihilar biliary stenosis-associated cholangitis.

• Biliary stenosis
• Portal vein embolization
• cholangitis
• liver atrophy
• radiological intervention

Portal vein embolization (PVE) is performed to reduce the risk of liver failure and subsequent mortality after major liver resection. Although a cut‐off value of 2·7 per cent per min per m² has been used with hepatobiliary scintigraphy (HBS) for future remnant liver function (FRLF), patients with perihilar cholangiocarcinoma (PHC) potentially benefit from an additional cut‐off of 8·5 per cent/min (not corrected for body surface area). Since January 2016 a more liberal approach to PVE has been adopted, including this additional cut‐off for HBS of 8·5 per cent/min. The aim of this study was to assess the effect of this approach on liver failure and mortality.

This was a single‐centre retrospective study in which consecutive patients undergoing liver resection under suspicion of PHC in 2000–2015 were compared with patients treated in 2016–2019, after implementation of the more liberal approach. Primary outcomes were postoperative liver failure (International Study Group of Liver Surgery grade B/C) and 90‐day mortality.

Some 191 patients with PHC underwent liver resection. PVE was performed in 6·4 per cent (9 of 141) of the patients treated in 2000–2015 and in 32 per cent (16 of 50) of those treated in 2016–2019. The 90‐day mortality rate decreased from 16·3 per cent (23 of 141) to 2 per cent (1 of 50) (P = 0·009), together with a decrease in the rate of liver failure from 19·9 per cent (28 of 141) to 4 per cent (2 of 50) (P = 0·008). In 2016–2019, 24 patients had a FRLF greater than 8·5 per cent/min and no liver failure or death occurred, suggesting that 8·5 per cent/min is a reliable cut‐off for patients with suspected PHC.

The major decrease in liver failure and mortality rates in recent years and the simultaneous increased use of PVE suggests an important role for PVE in reducing adverse outcomes after surgery for PHC.

• Colorectal neoplasms
• Hepatic veins
• Hypertrophy
• Portal vein
• Therapeutic embolization

To evaluate the safety and feasibility of selective occlusion of the hepatic artery and portal vein (SOAP) for staged hepatectomy (SOAPS) in patients with hepatocellular carcinoma (HCC)

From December 2014 to August 2018, 9 patients with unresectable HCC were chosen to undergo SOAPS. SOAP without liver partition was performed in the first stage. The second stage was performed when future liver remnant (FLR) was equal to or bigger than 40% of the standard liver volume (SLV). The growth rate of FLR, perioperative outcomes, and survival data was recorded.

In the first stage, all the 9 patients completed SOAP. Two cases received radiological interventional method and 7 cases received open operation. None of them developed liver failure and died following SOAP. After SOAP, FLR increased 145.0 ml (115.0 to 210 ml) and 37.1% (25.6 to 51.7%) on average. The average time interval between the two stages was 14.1 days (8 to 18 days). In the second stage, no in-hospital deaths occurred after SOAPS. One patient suffered from liver failure after SOAPS, and artificial liver support was adopted and his total bilirubin level returned to normal after postoperative day 35. The alpha-fetoprotein level of 8 patients reduced to normal within 2 months after SOAPS. Among 9 patients, 5 patients survived, 4 patients died of intrahepatic recurrence, lung metastasis, or bone metastasis. In the 5 survived cases, bone metastasis and intrahepatic recurrence were found in 1 patient, intrahepatic recurrence was found in another patient, and the remaining 3 patients were free of recurrence. The median disease-free survival time and overall survival time were 10.4 and 13.9 months, respectively.

SOAP can facilitate rapid and sustained FLR hypertrophy, and SOAPS is safe and effective in patients with unresectable HCC.

• Future liver remnant
• Hepatic artery ligation
• Hepatocellular carcinoma
• Portal vein ligation
• Staged hepatectomy

• Liver venous deprivation (LVD)
• hepatectomy
• liver failure
• portal embolization

When the inferior right hepatic vein (IRHV) is present, left hepatic trisectionectomy with resection of the right hepatic vein (RHV) is theoretically possible without reconstruction of the RHV. We here report a successful case of this extended hepatectomy after RHV embolization for advanced intrahepatic cholangiocarcinoma.

A 71-year-old man was admitted to our clinic with abdominal pain. Computed tomography showed a cholangiocarcinoma located at the caudate lobe that involved the inferior vena cava (IVC) and the roots of the three major hepatic veins. Portal vein embolization of the left and right anterior portal veins was performed. As the IRHV was present but thin, RHV was also embolized. Left hepatic trisectionectomy with resection of the involved IVC and RHV, preserving the IRHV, was done. The IVC was reconstructed with artificial graft. The patient was discharged on postoperative day 36.

RHV embolization is useful in extended left trisectionectomy with resection of the RHV when the IRHV is present but thin.

• Intrahepatic cholangiocarcinoma
• Left hepatic trisectionectomy
• Right hepatic vein embolization

• colorectal liver metastasis
• future liver remnant
• portal vein embolization
• two-stage hepatectomy

• Animals
• Disease Models, Animal
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Hepatic Veins
• Hepatomegaly/diagnosis
• Hepatomegaly/etiology
• Ligation/adverse effects
• Liver/blood supply
• Liver/diagnostic imaging
• Organ Size
• Portal Vein/surgery
• Random Allocation
• Swine
• Ultrasonography

• Embolization
• Hepatectomy
• Liver hypertrophy
• Radiological technique
• Surgical technique

• embolization
• hepatectomy
• radiofrequency
• portal vein.
• embolização
• hepatectomia
• radiofrequência
• veia porta.

• Animals
• Catheter Ablation
• Embolization, Therapeutic
• Female
• Hepatectomy/methods
• Male
• Portal Vein
• Swine