|
1
|
Al Taweel B, Cassese G, Khayat S, Chazal M, Navarro F, Guiu B, Panaro F. Assessment of Segmentary Hypertrophy of Future Remnant Liver after Liver Venous Deprivation: A Single-Center Study. Cancers (Basel) 2024; 16:1982. [PMID: 38893103 PMCID: PMC11171007 DOI: 10.3390/cancers16111982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/22/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Liver venous deprivation (LVD) is a recent radiological technique that has shown promising results on Future Remnant Liver (FRL) hypertrophy. The aim of this retrospective study is to compare the segmentary hypertrophy of the FRL after LVD and after portal vein embolization (PVE). Methods: Patients undergoing PVE or LVD between April 2015 and April 2020 were included. The segmentary volumes (seg 4, seg2+3 and seg1) were assessed before and after the radiological procedure. Results: Forty-four patients were included: 26 undergoing PVE, 10 LVD and 8 eLVD. Volume gain of both segment 1 and segments 2+3 was significantly higher after LVD and eLVD than after PVE (segment 1: 27.33 ± 35.37 after PVE vs. 38.73% ± 13.47 after LVD and 79.13% ± 41.23 after eLVD, p = 0.0080; segments 2+3: 40.73% ± 40.53 after PVE vs. 45.02% ± 21.53 after LVD and 85.49% ± 45.51 after eLVD, p = 0.0137), while this was not true for segment 4. FRL hypertrophy was confirmed to be higher after LVD and eLVD than after PVE (33.53% ± 21.22 vs. 68.63% ± 42.03 vs. 28.11% ± 28.33, respectively, p = 0.0280). Conclusions: LVD and eLVD may induce greater hypertrophy of segment 1 and segments 2+3 when compared to PVE.
Collapse
Affiliation(s)
- Bader Al Taweel
- Department of Digestive Surgery and Liver Transplantation, Montpellier University Hospital, 34090 Montpellier, France (S.K.)
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery and Transplantation Service, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Salah Khayat
- Department of Digestive Surgery and Liver Transplantation, Montpellier University Hospital, 34090 Montpellier, France (S.K.)
- Department of Visceral and Digestive Surgery, Centre Hospitalier de Perpignan, 66000 Perpignan, France
| | - Maurice Chazal
- Department of General and Visceral Surgery, Centre Hospitalier Princesse Grace, 98000 Monaco, Monaco;
| | - Francis Navarro
- Department of Digestive Surgery and Liver Transplantation, Montpellier University Hospital, 34090 Montpellier, France (S.K.)
| | - Boris Guiu
- Department of Diagnostic and Interventional Radiology, Montpellier University Hospital, 34090 Montpellier, France;
| | - Fabrizio Panaro
- Department of Digestive Surgery and Liver Transplantation, Montpellier University Hospital, 34090 Montpellier, France (S.K.)
- Department of Surgery, Università del Piemonte Orientale, 15121 Alessandria, Italy
| |
Collapse
|
|
2
|
Portal Vein Embolization: Rationale, Techniques, and Outcomes to Maximize Remnant Liver Hypertrophy with a Focus on Contemporary Strategies. Life (Basel) 2023; 13:life13020279. [PMID: 36836638 PMCID: PMC9959051 DOI: 10.3390/life13020279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Hepatectomy remains the gold standard for curative therapy for patients with limited primary or metastatic hepatic tumors as it offers the best survival rates. In recent years, the indication for partial hepatectomy has evolved away from what will be removed from the patient to the volume and function of the future liver remnant (FLR), i.e., what will remain. With this regard, liver regeneration strategies have become paramount in transforming patients who previously had poor prognoses into ones who, after major hepatic resection with negative margins, have had their risk of post-hepatectomy liver failure minimized. Preoperative portal vein embolization (PVE) via the purposeful occlusion of select portal vein branches to promote contralateral hepatic lobar hypertrophy has become the accepted standard for liver regeneration. Advances in embolic materials, selection of treatment approaches, and PVE with hepatic venous deprivation or concurrent transcatheter arterial embolization/radioembolization are all active areas of research. To date, the optimal combination of embolic material to maximize FLR growth is not yet known. Knowledge of hepatic segmentation and portal venous anatomy is essential before performing PVE. In addition, the indications for PVE, the methods for assessing hepatic lobar hypertrophy, and the possible complications of PVE need to be fully understood before undertaking the procedure. The goal of this article is to discuss the rationale, indications, techniques, and outcomes of PVE before major hepatectomy.
Collapse
|
|
3
|
Cassese G, Han HS, Lee B, Cho JY, Lee HW, Guiu B, Panaro F, Troisi RI. Portal vein embolization failure: Current strategies and future perspectives to improve liver hypertrophy before major oncological liver resection. World J Gastrointest Oncol 2022; 14:2088-2096. [PMID: 36438704 PMCID: PMC9694272 DOI: 10.4251/wjgo.v14.i11.2088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/01/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022] Open
Abstract
Portal vein embolization (PVE) is currently considered the standard of care to improve the volume of an inadequate future remnant liver (FRL) and decrease the risk of post-hepatectomy liver failure (PHLF). PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after resection. The degree of hypertrophy obtained after PVE is variable and depends on multiple factors. Up to 20% of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure (usually 6-8 wk are needed before surgery). The management of PVE failure is still debated, with a lack of consensus regarding the best clinical strategy. Different additional techniques have been proposed, such as sequential transarterial chemoembolization followed by PVE, segment 4 PVE, intra-portal administration of stem cells, dietary supplementation, and hepatic vein embolization. The aim of this review is to summarize the up-to-date strategies to overcome such difficult situations and discuss future perspectives on improving FRL hypertrophy.
Collapse
Affiliation(s)
- Gianluca Cassese
- Clinical Medicine and Surgery, Federico II University, Naples 80131, Italy
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seongnam 13620, South Korea
| | - Boram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University College of Medicine, Seongnam 13620, South Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
| | - Boris Guiu
- Department of Medical Imaging and Interventional Radiology, St-Eloi University Hospital, Montpellier 34295, France
| | - Fabrizio Panaro
- Digestive Surgery and Transplantation, CHU de Montpellier, Montpellier 34295, France
| | | |
Collapse
|
|
4
|
Reese T, Galavics C, Schneider M, Brüning R, Oldhafer KJ. Sarcopenia influences the kinetic growth rate after ALPPS. Surgery 2022; 172:926-932. [DOI: 10.1016/j.surg.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
|
|
5
|
The evolution of surgery for colorectal liver metastases: A persistent challenge to improve survival. Surgery 2021; 170:1732-1740. [PMID: 34304889 DOI: 10.1016/j.surg.2021.06.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/01/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023]
Abstract
Only a few decades ago, the opinion that colorectal liver metastases were a palliative diagnosis changed. In fact, previously, the prevailing view was strongly resistant against resecting colorectal liver metastases. Constant technical improvement of liver surgery and, much later, effective chemotherapy allowed for a successful wider application of surgery. The clinical use of portal vein embolization was the starting signal of regenerative liver surgery, where insufficient liver volume can be expanded to an extent where safe resection is possible. Today, a number of these techniques including portal vein ligation, associating liver partition and portal vein ligation for staged hepatectomy, and bi-embolization (portal and hepatic vein) can be successfully used to address an insufficient future liver remnant in staged resections. It turned out that the road to success is embedding surgery in a well-orchestrated oncological concept of controlling systemic disease. This concept was the prerequisite that meant liver transplantation could enter the treatment strategy for colorectal liver metastases, ending up with a 5-year overall survival of 80% in highly selected cases. In particular, techniques combining principles of 2-stage hepatectomy and liver transplantation, such as "resection and partial liver segment 2-3 transplantation with delayed total hepatectomy" (RAPID) are on the rise. These techniques enable the use of partial liver grafts with primarily insufficient liver volume. All this progress also prompted a number of innovative local therapies to address recurrences ultimately transferring colorectal liver metastases from instantly deadly into a chronic disease in some cases.
Collapse
|
|
6
|
Soykan EA, Aarts BM, Lopez-Yurda M, Kuhlmann KFD, Erdmann JI, Kok N, van Lienden KP, Wilthagen EA, Beets-Tan RGH, van Delden OM, Gomez FM, Klompenhouwer EG. Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review. Cardiovasc Intervent Radiol 2021; 44:1355-1366. [PMID: 34142192 PMCID: PMC8382618 DOI: 10.1007/s00270-021-02877-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/18/2021] [Indexed: 12/15/2022]
Abstract
This systematic review was conducted to determine factors that are associated with the degree of hypertrophy of the future liver remnant following portal vein embolization. An extensive search on September 15, 2020, and subsequent literature screening resulted in the inclusion of forty-eight articles with 3368 patients in qualitative analysis, of which 18 studies were included in quantitative synthesis. Meta-analyses based on a limited number of studies showed an increase in hypertrophy response when additional embolization of segment 4 was performed (pooled difference of medians = − 3.47, 95% CI − 5.51 to − 1.43) and the use of N-butyl cyanoacrylate for portal vein embolization induced more hypertrophy than polyvinyl alcohol (pooled standardized mean difference (SMD) = 0.60, 95% CI 0.30 to 0.91). There was no indication of a difference in degree of hypertrophy between patients who received neo-adjuvant chemotherapy and those who did not receive pre-procedural systemic therapy (pooled SMD = − 0.37, 95% CI − 1.35 to 0.61), or between male and female patients (pooled SMD = 0.19, 95% CI − 0.12 to 0.50). The study was registered in the International Prospective Register of Systematic Reviews on April 28, 2020 (CRD42020175708).
Collapse
Affiliation(s)
- E. A. Soykan
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - B. M. Aarts
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M. Lopez-Yurda
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K. F. D. Kuhlmann
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J. I. Erdmann
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N. Kok
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K. P. van Lienden
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E. A. Wilthagen
- Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R. G. H. Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - O. M. van Delden
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F. M. Gomez
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Interventional Radiology, Hospital Clinic Universitari de Barcelona, Barcelona, Spain
| | - E. G. Klompenhouwer
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
|
7
|
Denbo JW, Kim BJ, Vauthey JN, Tzeng CW, Ma J, Huang SY, Chun YS, Katz MHG, Aloia TA. Overall Body Composition and Sarcopenia Are Associated with Poor Liver Hypertrophy Following Portal Vein Embolization. J Gastrointest Surg 2021; 25:405-410. [PMID: 31997073 DOI: 10.1007/s11605-020-04522-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/16/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE To explore whether body composition and/or sarcopenia are associated with liver hypertrophy following portal vein embolization (PVE) in patients with colorectal liver metastases (CLM). METHODS Patients with CLM who underwent right PVE prior to a planned right hepatectomy were identified from the institutional liver database from 2004 to 2014. Patients were excluded due to previous liver-directed therapy/hepatectomy, right PVE + segment IV embolization, or planned 2-stage hepatectomy. Advanced imaging software was used to measure body compartment volumes (cm2), which were standardized to height (m2) to create an index: skeletal muscle index (SMI), subcutaneous adipose index (SAI), and visceral adipose index (VAI). SMI, gender, and body mass index (BMI) were used to define sarcopenia. The main outcome of interest was hypertrophy of the future liver remnant (FLR) following PVE, which was reported as degree of hypertrophy (DH) and kinetic growth rate (KGR). RESULTS Patients were evenly divided into three KGR groups: lower third (KGR:0.7-2.0%), middle third (KGR:2.0-4.1%), and upper third (KGR:4.2-12.3%). Patients in the lower third KGR group had a lower VAI (31.0 vs 53.0 vs 54.5 cm2/m2, p = 0.042) and were more commonly sarcopenic (60%) compared to the upper third (20%, p = 0.025). Eighteen patients (40%) met criteria for sarcopenia. Sarcopenic patients had a lower VAI (29.1 vs 57.4 cm2/m2, p = 0.004), lesser degree of hypertrophy (8.3% vs 15.2%, p = 0.009), and lower KGR (2.0% vs 4.0%, p = 0.012). CONCLUSION Sarcopenia and associated body composition indices are strongly associated with clinically relevant impaired liver regeneration, which may result in increased liver-specific complications following hepatectomy for CLM.
Collapse
Affiliation(s)
- Jason W Denbo
- Department of Gastrointestinal Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1484, Houston, TX, 77030, USA
| | - Bradford J Kim
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1484, Houston, TX, 77030, USA
| | - Jean-Nicolas Vauthey
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1484, Houston, TX, 77030, USA
| | - Ching-Wei Tzeng
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1484, Houston, TX, 77030, USA
| | - Jingfei Ma
- Departments of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven Y Huang
- Departments of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun S Chun
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1484, Houston, TX, 77030, USA
| | - Matthew H G Katz
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1484, Houston, TX, 77030, USA
| | - Thomas A Aloia
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1484, Houston, TX, 77030, USA.
| |
Collapse
|
|
8
|
Future Liver Remnant (FLR) Increase in Patients with Colorectal Liver Metastases Is Highest the First Week After Portal Vein Occlusion : FLR Increase in Patients with CRLM Is Highest the First Week After PVO. J Gastrointest Surg 2019; 23:556-562. [PMID: 30465187 PMCID: PMC6414468 DOI: 10.1007/s11605-018-4031-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/21/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Portal vein occlusion (PVO) is an established method to increase the volume of the future liver remnant (FLR). The main reasons for not proceeding to radical hepatectomy are lack of volume increase and tumor progression due to a wait-time interval of up to 8 weeks. The hypothesis was that the increase in FLR volume is not linear and is largest during the first weeks. METHODS Patients with colorectal liver metastases (CRLM) and standardized future liver remnant (sFLR) < 30% treated with PVO were prospectively included. All patients had at least one CT evaluation before radical hepatectomy. RESULTS Forty-eight patients were included. During the first week after PVO, the kinetic growth rate (KGR) was 5.4 (± 4), compared to 1.5 (± 2) between the first and second CT (p < 0.05). For patients reaching adequate FLR and therefore treated with radical hepatectomy, the KGR was 7 (± 4) the first week, compared to 4.3 (± 2) for patients who failed to reach a sufficient volume (p = 0.4). During the interval between the first and second CT, the KGR was 2.2 (± 2), respectively (± 0.1) (p = 0.017). DISCUSSION The increase in liver volume after PVO is largest during the first week. As KGR decreases over time, it is important to shorten the interval between PVO and the first volume evaluation; this may aid in decision-making and reduce unnecessary waiting time.
Collapse
|
|
9
|
Watanabe N, Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, Aramaki T, Uesaka K. A predictive scoring system for insufficient liver hypertrophy after preoperative portal vein embolization. Surgery 2018; 163:1014-1019. [PMID: 29501348 DOI: 10.1016/j.surg.2017.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/31/2017] [Accepted: 11/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The factors which affect hypertrophy of the future liver remnant after portal vein embolization remain unclear. The aim of this study was to clarify the clinical factors affecting the hypertrophy rate after portal vein embolization and to develop a scoring system predicting insufficient liver hypertrophy. METHODS The cases of a total of 152 patients who underwent portal vein embolization of the right portal branch between 2006 and 2016 were reviewed retrospectively. The score to predict insufficient (<25%) hypertrophy was established based on logistic regression analyses of the clinical parameters before portal vein embolization. RESULTS After portal vein embolization, the future liver remnant volume, expressed as the median (range), significantly increased from 364 (151-801) mL, 33% (18%-54%), to 451 (242-866) mL, 42% (26%-65%). The median hypertrophy rate was 24% (-5% to 96%). A preoperative predictive scoring system for insufficient liver hypertrophy was constructed using the following 3 factors: an initial future liver remnant volume ≥35% (2 points), alkaline phosphatase ≥450 IU/dL (1 point), and cholinesterase <220 mg/dL (1 point). The constructed scoring system indicated the proportion of patients with insufficient liver hypertrophy (<25%) to be 6 out of 42 (14%) in the low-score group (0 points), 44 out of 77 (57%) in the medium-score group (1-2 points), and 30 out of 33 (91%) in the high-score group (3-4 points). The hypertrophy rate of future liver remnant was different among the 3 groups (low-score group, 38.9% [-2.4% to 81.4%]; medium-score group, 22.7% [-5.1% to 95.5%]; high-score group, 18.2% [2.4%-30.7%]) (P < .001). CONCLUSION The constructed scoring system was able to stratify patients before portal vein embolization according to the possibility of developing insufficient liver hypertrophy.
Collapse
Affiliation(s)
- Nobuyuki Watanabe
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takeshi Aramaki
- Division of Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| |
Collapse
|
|
10
|
Omichi K, Yamashita S, Cloyd JM, Shindoh J, Mizuno T, Chun YS, Conrad C, Aloia TA, Vauthey JN, Tzeng CWD. Portal Vein Embolization Reduces Postoperative Hepatic Insufficiency Associated with Postchemotherapy Hepatic Atrophy. J Gastrointest Surg 2018; 22:60-67. [PMID: 28585106 DOI: 10.1007/s11605-017-3467-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/23/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The risk of postoperative hepatic insufficiency (PHI) is increased among patients with significant postchemotherapy hepatic atrophy. The primary aim of this study was to evaluate whether the liver regeneration stimulated by portal vein embolization (PVE) can protect against PHI. METHODS Clinicopathological features of 177 patients treated with preoperative chemotherapy followed by PVE and hepatectomy were reviewed. Degree of atrophy was defined as the ratio of percentage difference in total liver volume (estimated by manual volumetry) to standardized liver volume. Kinetic growth rate (KGR, degree of hypertrophy [absolute % change in future liver remnant volume] divided by the number of weeks after PVE) and PHI events were compared between patients with degree of atrophy <10 vs ≥10%. Risk factors for the PHI were assessed using logistic regression. RESULTS Seventy patients (40%) experienced significant hepatic atrophy ≥10% following preoperative chemotherapy. PHI rates were not significantly increased in patients who experienced significant hepatic atrophy (5.6 vs 8.6%, P = 0.443). KGR <2%/week (odds ratio, 8.10, P = 0.037) was the sole independent preoperative predictor of PHI. KGR ≥2% was associated with decreased PHI in both patients with <10% atrophy (0 vs 9.5%, P = 0.035) and ≥10% atrophy (2.6 vs 16.0%, P = 0.044). CONCLUSIONS Even in high-risk patients with ≥10% degree of atrophy from preoperative chemotherapy, KGR ≥2% mitigates the deleterious effects of hepatic atrophy and significantly reduces PHI to almost zero. In these high-risk patients, PVE with KGR calculation remains the most important preoperative technique to reduce liver failure after major hepatectomy.
Collapse
Affiliation(s)
- Kiyohiko Omichi
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Suguru Yamashita
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Jordan M Cloyd
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Junichi Shindoh
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
- Department of Digestive Surgery, Hepatobiliary-Pancreatic, Surgery Division, Toranomon Hospital, Tokyo, Japan
| | - Takashi Mizuno
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Claudius Conrad
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1484, Houston, TX, 77030, USA.
| |
Collapse
|
|
11
|
Huang SY, Aloia TA. Portal Vein Embolization: State-of-the-Art Technique and Options to Improve Liver Hypertrophy. Visc Med 2017; 33:419-425. [PMID: 29344515 DOI: 10.1159/000480034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Portal vein embolization (PVE) is associated with a high technical and clinical success rate for induction of future liver remnant hypertrophy prior to surgical resection. The degree of hypertrophy is variable and depends on multiple factors, including technical aspects of the procedure and underlying chronic liver disease. For patients with insufficient liver volume following PVE, adjunctive techniques, such as intra-portal administration of stem cells, dietary supplementation, transarterial embolization, and hepatic vein embolization, are available. Our purpose is to review the state-of-the-art technique associated with high-quality PVE and to discuss options to improve hypertrophy of the future liver remnant.
Collapse
Affiliation(s)
- Steven Y Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
|
12
|
A colon targeted drug delivery system based on alginate modificated graphene oxide for colorectal liver metastasis. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017. [DOI: 10.1016/j.msec.2017.05.054] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
|
13
|
Margonis GA, Buettner S, Andreatos N, Sasaki K, Pour MZ, Deshwar A, Wang J, Ghasebeh MA, Damaskos C, Rezaee N, Pawlik TM, Wolfgang CL, Kamel IR, Weiss MJ. Preoperative bevacizumab and volumetric recovery after resection of colorectal liver metastases. J Surg Oncol 2017; 116:1150-1158. [DOI: 10.1002/jso.24769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/26/2017] [Indexed: 12/14/2022]
Affiliation(s)
| | - Stefan Buettner
- Department of Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | | | - Kazunari Sasaki
- Department of Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | | | - Ammar Deshwar
- Department of Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Jane Wang
- Department of Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | | | - Christos Damaskos
- Second Department of Propaedeutic Surgery; Laiko Hospital; University of Athens; Athens Greece
| | - Neda Rezaee
- Department of Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Timothy M. Pawlik
- Department of Surgery; The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center; Columbus Ohio
| | | | - Ihab R. Kamel
- Department of Radiology; The Johns Hopkins Hospital; Baltimore Maryland
| | - Matthew J. Weiss
- Department of Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| |
Collapse
|
|
14
|
Narula N, Aloia TA. Portal vein embolization in extended liver resection. Langenbecks Arch Surg 2017; 402:727-735. [DOI: 10.1007/s00423-017-1591-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
|
|
15
|
Hasselgren K, Malagò M, Vyas S, Campos RR, Brusadin R, Linecker M, Petrowsky H, Clavien PA, Machado MA, Hernandez-Alejandro R, Wanis K, Valter L, Sandström P, Björnsson B. Neoadjuvant chemotherapy does not affect future liver remnant growth and outcomes of associating liver partition and portal vein ligation for staged hepatectomy. Surgery 2017; 161:1255-1265. [PMID: 28081953 DOI: 10.1016/j.surg.2016.11.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/09/2016] [Accepted: 11/30/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The only potentially curative treatment for patients with colorectal liver metastases is hepatectomy. Associating liver partition and portal vein ligation for staged hepatectomy has emerged as a method of treatment for patients with inadequate future liver remnant. One concern about associating liver partition and portal vein ligation for staged hepatectomy is that preoperative chemotherapy may negatively affect the volume increase of the future liver remnant and outcomes. METHODS This study from the International Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Registry (NCT01924741) includes 442 patients with colorectal liver metastases registered from 2012-2016. Future liver remnant hypertrophy (absolute increase, percent increase, and kinetic growth rate) and clinical outcome were analyzed retrospectively in relation to type and amount of chemotherapy. The analyzed groups included patients with no chemotherapy, 1 regimen of chemotherapy, >1 regimen, and a group that received monoclonal antibodies in addition to chemotherapy. RESULTS Ninety percent of the patients received neoadjuvant oncologic therapy including 42% with 1 regimen of chemotherapy, 44% with monoclonal antibodies, and 4% with >1 regimen. Future liver remnant increased between 74-92% with the largest increase in the group with 1 regimen of chemotherapy. The increase in milliliters was between 241 mL (>1 regimen) and 306 mL (1 regimen). Kinetic growth rate was between 14-18% per week and was greatest for the group with 1 regimen of chemotherapy. No statistical significance was found between the groups with any of the measurements of future liver remnant hypertrophy. CONCLUSION Neoadjuvant chemotherapy, including monoclonal antibodies, does not negatively affect future liver remnant growth. Patients with colorectal liver metastases who might be potential candidates for associating liver partition and portal vein ligation for staged hepatectomy should be considered for neoadjuvant chemotherapy.
Collapse
Affiliation(s)
- Kristina Hasselgren
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Massimo Malagò
- Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, Division of Surgical and Interventional Sciences, University College London, Royal Free Hospital, London, United Kingdom
| | - Soumil Vyas
- Department of Hepatopancreaticobiliary Surgery and Liver Transplantation, Division of Surgical and Interventional Sciences, University College London, Royal Free Hospital, London, United Kingdom
| | - Ricardo Robles Campos
- Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - Roberto Brusadin
- Department of General Surgery, Liver Transplant Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - Michael Linecker
- Department of Surgery and Transplantation, Swiss Hepatopancreaticobiliary and Transplant Center Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Henrik Petrowsky
- Department of Surgery and Transplantation, Swiss Hepatopancreaticobiliary and Transplant Center Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Pierre Alain Clavien
- Department of Surgery and Transplantation, Swiss Hepatopancreaticobiliary and Transplant Center Zürich, University Hospital Zürich, Zürich, Switzerland
| | | | | | - Kerollos Wanis
- Department of Surgery, Western University, London, Ontario, Canada
| | - Lars Valter
- Research and Development Unit in Local Healthcare, Linköping University, Linköping, Sweden
| | - Per Sandström
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Bergthor Björnsson
- Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| |
Collapse
|
|
16
|
Mise Y, Passot G, Wang X, Chen HC, Wei S, Brudvik KW, Aloia TA, Conrad C, Huang SY, Vauthey JN. A Nomogram to Predict Hypertrophy of Liver Segments 2 and 3 After Right Portal Vein Embolization. J Gastrointest Surg 2016; 20:1317-23. [PMID: 27073080 DOI: 10.1007/s11605-016-3145-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Portal vein embolization (PVE) reduces the risks of hepatic insufficiency after major hepatectomy for small predicted liver remnant. The extent of liver hypertrophy after PVE depends on various clinical factors. We sought to develop a nomogram for predicting the increase in the volume of segments 2 and 3 after right PVE (RPVE). METHOD In 360 patients who underwent RPVE from 1998 through 2013, clinicopathologic data were analyzed, including body mass index (BMI), diabetes, aspirin use, viral hepatitis status, preoperative albumin level, total bilirubin level, prothrombin time, platelet count, type of liver neoplasm, preoperative chemotherapy, previous laparotomy or hepatectomy, segment 4 embolization, two-stage hepatectomy, and liver volumes before and after PVE. Multivariate linear regression analysis was used to identify variables predicting the degree of hypertrophy of segments 2 and 3. RESULTS Multivariate regression analysis revealed that BMI (p = 0.002), previous hepatectomy (p = 0.03), RPVE in the setting of two-stage hepatectomy (p < 0.001), and segment 4 embolization (p = 0.003) independently predicted the degree of hypertrophy of segments 2 and 3. Based on the fitted model, a nomogram was constructed. CONCLUSION The constructed nomogram predicts the degree of hypertrophy of segments 2 and 3 after RPVE and can be used in clinical decision making for patients undergoing right hepatectomy.
Collapse
Affiliation(s)
- Yoshihiro Mise
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Guillaume Passot
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Hsiang-Chun Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Steven Wei
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Kristoffer W Brudvik
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Claudius Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA
| | - Steven Y Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX, 77030, USA.
| |
Collapse
|
|
17
|
Simoneau E, Alanazi R, Alshenaifi J, Molla N, Aljiffry M, Medkhali A, Boucher LM, Asselah J, Metrakos P, Hassanain M. Neoadjuvant chemotherapy does not impair liver regeneration following hepatectomy or portal vein embolization for colorectal cancer liver metastases. J Surg Oncol 2016; 113:449-55. [PMID: 26955907 DOI: 10.1002/jso.24139] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/08/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Treatment strategies for colorectal cancer liver metastasis (CRCLM) such as major hepatectomy and portal vein embolization (PVE) rely on liver regeneration. We aim to investigate the effect of neoadjuvant chemotherapy on liver regeneration occurring after PVE and after major hepatectomy. METHODS CRCLM patients undergoing PVE or major resection were identified retrospectively from our database. Liver regeneration data (expressed as future liver remnant [FLR] and percentage of liver regeneration [%LR]), total liver volume (TLV) and clinical characteristics were collected. RESULTS Between 2003 and 2013, 226 patients were included (85 major resection, 141 PVE). The median chemotherapy cycles was six in both groups. The median time interval between the last chemotherapy and the intervention was 51 days in the PVE group and 79 days in the hepatectomy group. In the PVE group, chemotherapy was not associated with altered liver regeneration (number of cycles [P = 0.435], timing [P = 0.563], or chemotherapy agent [P = 0.116]). Similarly in the major hepatectomy group, preoperative chemotherapy (number of cycles [P = 0.114]; agent [P = 0.061], timing [P = 0.126]) were not significantly associated with differences in liver regeneration (P = 0.592). In both groups, the predicted FLR% was inversely correlated with the %LR (P < 0.001). CONCLUSION Chemotherapy does not affect liver regeneration following PVE or major resection. J. Surg. Oncol. 2016;113:449-455. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Eve Simoneau
- Department of Surgery, McGill University, Montreal, Canada
| | - Reema Alanazi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jumanah Alshenaifi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nouran Molla
- Department of Radiology, McGill University, Montreal, Canada
| | - Murad Aljiffry
- Department of Surgery, College of Medicine King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Medkhali
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Jamil Asselah
- Department of Oncology, McGill University, Montreal, Canada
| | - Peter Metrakos
- Department of Surgery, McGill University, Montreal, Canada
| | - Mazen Hassanain
- Department of Surgery, McGill University, Montreal, Canada.,Department of Oncology, McGill University, Montreal, Canada
| |
Collapse
|
|
18
|
Thirunavukarasu P, Aloia TA. Preoperative Assessment and Optimization of the Future Liver Remnant. Surg Clin North Am 2016; 96:197-205. [PMID: 27017859 DOI: 10.1016/j.suc.2015.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Liver resection of benign, primary, and metastatic tumors is challenging and places patients at risk for postoperative liver insufficiency. The magnitude of this risk largely depends on the volume and function of the future liver remnant (FLR). It is, therefore, critical that hepatobiliary surgeons are well versed in measurement of liver volume and function as well as various techniques for preoperative liver volume augmentation. The absolute volume of FLR required to avoid postoperative liver insufficiency depends on patient, disease, and anatomic factors. Rapid expansion of the FLR can safely be achieved with portal venous embolization of the contralateral liver segments.
Collapse
Affiliation(s)
- Pragatheeshwar Thirunavukarasu
- HPB Surgery Section, Department of Surgical Oncology, UT-MD Anderson Cancer Center, 1400 Herman Pressler Drive, Unit 1484, Houston, TX 77030, USA
| | - Thomas A Aloia
- HPB Surgery Section, Department of Surgical Oncology, UT-MD Anderson Cancer Center, 1400 Herman Pressler Drive, Unit 1484, Houston, TX 77030, USA.
| |
Collapse
|
|
19
|
Wilms C, Radtke A, Beckebaum S, Cicinatti V, Schmidt H. Prävention und Therapie des postoperativen Leberversagens. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-014-1080-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
|
20
|
Pommier R, Ronot M, Cauchy F, Gaujoux S, Fuks D, Faivre S, Belghiti J, Vilgrain V. Colorectal liver metastases growth in the embolized and non-embolized liver after portal vein embolization: influence of initial response to induction chemotherapy. Ann Surg Oncol 2014; 21:3077-83. [PMID: 24743912 DOI: 10.1245/s10434-014-3700-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare tumor progression in both embolized and non-embolized liver lobes after portal vein embolization (PVE) in patients with bilobar colorectal liver metastases (CLM), according to the initial response to induction chemotherapy. METHODS From 2002 to 2012, a total of 42 consecutive patients with bilobar CLM initially treated using induction chemotherapy underwent right PVE to achieve adequate future liver remnant volume. Tumoral and liver parenchyma volumes, as well as their volume variations, were measured on computed tomography before and after PVE in both embolized and non-embolized. Patients were classified as fast (≤6 cycles of induction chemotherapy) and slow (>6 cycles) responders. RESULTS Overall, 432 metastases were analyzed in 42 patients. Patients were slow responders in 29 (69 %) cases. Tumoral volume increased in 29 (69 %) cases in the embolized liver (+48 %; p < 0.0001), and in 28 (66 %) cases in the non-embolized liver (+31 %; p < 0.0001). Fast responders had a tumoral volume decrease in both embolized (-4 %) and non-embolized (-9 %) lobes. On the opposite side, slow responders had tumoral volume increase in both embolized (+79 %) and non-embolized (+32 %) lobes. On multivariate analysis, a 'slow' response to induction chemotherapy was the only factor associated with tumoral progression in both embolized (p = 0.0012) and non-embolized (p = 0.001) lobes. CONCLUSION Tumor growth after PVE is observed in both embolized and non-embolized liver lobes in most patients but is significantly associated with slow response to induction chemotherapy.
Collapse
Affiliation(s)
- Romain Pommier
- Department of Radiology, Beaujon Hospital (AP-HP), Beaujon University Hospitals Paris Nord Val de Seine, Clichy, Hauts-de-Seine, France
| | | | | | | | | | | | | | | |
Collapse
|
|
21
|
Higuchi R, Yamamoto M. Indications for portal vein embolization in perihilar cholangiocarcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 21:542-9. [DOI: 10.1002/jhbp.77] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology; Tokyo Women's Medical University; 8-1 Kawada-cho Shinjuku-ku Tokyo 162-8666 Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology; Tokyo Women's Medical University; 8-1 Kawada-cho Shinjuku-ku Tokyo 162-8666 Japan
| |
Collapse
|
|
22
|
[Neoadjuvant chemotherapy or primary surgery for colorectal liver metastases. Pro primary surgery]. Chirurg 2013; 85:17-23. [PMID: 24337153 DOI: 10.1007/s00104-013-2565-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Approximately 50 % of patients with colorectal cancer (CRC) develop liver metastases, with the liver being the only site of metastasis in the majority of patients. Liver resection is the standard treatment of CRC liver metastases as it achieves a 5-year survival of 36-51 %. The primary goal in the treatment of non-resectable liver metastases is to achieve resectability by preoperative chemotherapy as even secondary liver resection after down-sizing is associated with improved overall survival. Furthermore, resectability can be increased by two-stage surgical procedures; however, the assessment of resectability varies widely even among experts in the field. In cases of suspected non-resectability patients should therefore be liberally admitted for a second opinion to centers of liver surgery. Perioperative chemotherapy in primarily resectable cases has only demonstrated an improvement in recurrence-free survival in subgroup analyses. Moreover, modern potent chemotherapy regimens increase the surgical morbidity depending on the duration of treatment: the lower the histological response of the metastases and the more treatment cycles are applied, the higher is the parenchymal damage with related surgical morbidity. Therefore, perioperative chemotherapy of resectable liver metastases should be viewed with caution and should not be considered the standard of care.
Collapse
|
|
23
|
Sturesson C, Nilsson J, Eriksson S, Spelt L, Andersson R. Limiting factors for liver regeneration after a major hepatic resection for colorectal cancer metastases. HPB (Oxford) 2013; 15:646-652. [PMID: 23458360 PMCID: PMC3731588 DOI: 10.1111/hpb.12040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/28/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chemotherapy before resection of colorectal metastases in the liver is extensively used and has been shown to induce histopathological changes in the liver parenchyma, although little is known about the effect of chemotherapy on liver regeneration. The aim of this study was to determine if pre-operative chemotherapy influences the regenerated liver volume after a major liver resection. PATIENTS AND METHODS This retrospective cohort study included 74 patients subjected to a major liver resection for colorectal metastases. Patients were divided into two groups depending on whether they had been treated with chemotherapy less than 3 months before surgery or not. Liver volumes were measured before and 1 year after resection. RESULTS Pre-operative chemotherapy reduced volumetric liver regeneration (83 ± 2% versus 91 ± 2%; P = 0.007) as compared with patients without chemotherapy. There was a linear correlation between regenerated volume and time interval between the end of chemotherapy to resection (P = 0.031). CONCLUSIONS Pre-operative chemotherapy in patients with colorectal liver metastases negatively affects volume regeneration after a partial hepatectomy. The time interval between chemotherapy and surgery determines the impact of these affects.
Collapse
Affiliation(s)
- Christian Sturesson
- Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
| | | | | | | | | |
Collapse
|
|
24
|
Munene G, Parker RD, Larrigan J, Wong J, Sutherland F, Dixon E. Sequential preoperative hepatic vein embolization after portal vein embolization for extended left hepatectomy in colorectal liver metastases. World J Surg Oncol 2013; 11:134. [PMID: 23758777 PMCID: PMC3704685 DOI: 10.1186/1477-7819-11-134] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 06/02/2013] [Indexed: 02/07/2023] Open
Abstract
Background The role of portal vein embolization to increase future liver remnant (FLR) is well-established in the treatment of colorectal liver metastases. However, the role of hepatic vein embolization is unclear. Case report A patient with colorectal liver metastases received neoadjuvant chemotherapy prior to attempted resection. At the time of resection his tumor appeared to invade the left and middle hepatic vein, requiring an extended left hepatectomy including segments five and eight. Post-operatively, he underwent sequential left portal vein embolization followed by left hepatic vein embolization and finally, middle hepatic vein embolization. Hepatic vein embolization was performed to increase the FLR as well as to allow collateral drainage of the FLR to develop. A left trisectionectomy was then performed and no evidence of postoperative liver congestion or morbidity was found. Conclusion Sequential portal vein embolization and hepatic vein embolization for extended left hepatectomy may be considered to increase FLR and may prevent right hepatic congestion after sacrificing the middle vein.
Collapse
Affiliation(s)
- Gitonga Munene
- Department of General Surgery, University of Tennessee Health Center, 1325 Eastmoreland Avenue, Suite 140, Memphis, TN 38104-7540, USA
| | | | | | | | | | | |
Collapse
|
|
25
|
Treska V, Skalicky T, Sutnar A, Vaclav L, Fichtl J, Kinkorova J, Vachtova M, Narsanska A. Prognostic importance of some clinical and therapeutic factors for the effect of portal vein embolization in patients with primarily inoperable colorectal liver metastases. Arch Med Sci 2013; 9:47-54. [PMID: 23515176 PMCID: PMC3598138 DOI: 10.5114/aoms.2013.33348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 06/25/2011] [Accepted: 08/18/2011] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Portal vein embolization (PVE) may increase the resectability of liver metastases. However, the problem of PVE is insufficient growth of the liver or tumor progression in some patients. The aim of this study was to evaluate the significance of commonly available clinical factors for the result of PVE. MATERIAL AND METHODS Portal vein embolization was performed in 38 patients with colorectal liver metastases. Effects of age, gender, time between PVE and liver resection, oncological therapy after PVE, indocyanine green retention rate test, synchronous, metachronous and extrahepatic metastases, liver volume before and after PVE, increase of liver volume after PVE and the quality of liver parenchyma before PVE on the result of PVE were evaluated. RESULTS Liver resection was performed in 23 (62.2%) patients within 1.3 ±0.4 months after PVE. Tumor progression occurred in 9 (23.7%) patients and 6 (15.8%) patients had insufficient liver hypertrophy. Significant clinical factors of PVE failure were number of liver metastases (cut-off - 4; odds ratio - 4.7; p < 0.03), liver volume after PVE (cut-off 1000 cm(3); odds ratio - 5.1; p < 0.02), growth of liver volume after PVE (cut-off 150 cm(3); odds ratio - 18.7; p < 0.002), oncological therapy administered concomitantly with PVE (p < 0.003). CONCLUSIONS Negative clinical factors of resectability of colorectal cancer liver metastases after PVE included more than four liver metastases, liver volume after PVE < 1000 cm(3), growth of the contralateral lobe by less than 150 cm(3) and concurrent oncological therapy.
Collapse
Affiliation(s)
| | - Tomas Skalicky
- University Hospital, School of Medicine, Pilsen, Czech Republic
| | - Alan Sutnar
- University Hospital, School of Medicine, Pilsen, Czech Republic
| | - Liska Vaclav
- University Hospital, School of Medicine, Pilsen, Czech Republic
| | - Jakub Fichtl
- University Hospital, School of Medicine, Pilsen, Czech Republic
| | | | - Monika Vachtova
- University Hospital, School of Medicine, Pilsen, Czech Republic
| | | |
Collapse
|
|
26
|
Two-stage hepatectomy with effective perioperative chemotherapy does not induce tumor growth or growth factor expression in liver metastases from colorectal cancer. Surgery 2013; 153:179-88. [DOI: 10.1016/j.surg.2012.06.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/08/2012] [Indexed: 12/29/2022]
|
|
27
|
Volumetric analysis of remnant liver regeneration after major hepatectomy in bevacizumab-treated patients: a case-matched study in 82 patients. Ann Surg 2013; 256:755-61; discussion 761-2. [PMID: 23095619 DOI: 10.1097/sla.0b013e31827381ca] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The objective was to determine the liver regeneration capacity and morbidity and mortality rates after major hepatectomy for colorectal metastases in patients having undergone bevacizumab-based chemotherapy (bev+). PATIENTS AND METHODS Between 2006 and 2011, 41 patients underwent major hepatectomy within 3 months of bevacizumab and were matched with 41 patients operated on following systemic chemotherapy without bevacizumab (bev-). The matching criteria were the following: number of courses of chemotherapy, chemotherapy-free interval, age, and type of hepatectomy. After measurements of remnant liver volume (RLV) preoperatively and at 1 month (RLV1M), volumetric gain was calculated as absolute (RLV1M-RLV) or relative regeneration [(RLV1M-RLV/RLV)]. Ninety-day morbidity was rated according to the Clavien-Dindo classification. RESULTS There were 21 right, 9 extended right, and 11 left hepatectomies in each group. Groups were comparable in terms of matching criteria, body mass index, American Society of Anesthesiologists score, and RLV. No mortalities were observed. There were no intergroup differences in overall morbidity (56% in bev+ vs 34.1%; P = 0.075) or postoperative liver failure. A severe complication occurred in 5 bev+ (4 eviscerations) and 4 bev- (bile leakages) (P = 0.95). The median hospital stay was similar in both groups as were the degrees of absolute and relative liver regeneration (143% in bev+ vs 114%; P = 0.20). Liver regeneration was not influenced by the type of hepatectomy, the number of courses of chemotherapy, or age more than 65 years. CONCLUSIONS In a methodologically robust trial in the largest cohort reported up to date, bevacizumab did not impair liver regeneration after major hepatectomy-even in elderly patients or those with high exposure to chemotherapy.
Collapse
|
|
28
|
Spelt L, Norman P, Törnqvist L, Tingstedt B, Andersson R. Combined portal vein embolization and preoperative chemotherapy prior to liver resection for colorectal cancer metastases. Scand J Gastroenterol 2012; 47:975-983. [PMID: 22631611 DOI: 10.3109/00365521.2012.685751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Compare perioperative course and long-term mortality after liver resection for colorectal cancer (CRC) metastases between patients who had preoperative treatment with portal vein embolization (PVE) and chemotherapy or chemotherapy alone. METHODS Among patients undergoing liver resection for CRC metastases following preoperative chemotherapy treatment, 17 patients who had received preoperative PVE (group A) were compared with 17 matched controls who had no PVE (group B). Perioperative course and long-term mortality were compared between groups A and B and between group A and the entire group of 75 cases with preoperative chemotherapy (group C). RESULTS Baseline characteristics for the matched groups A and B were similar. Group C included less major resections. Median intraoperative bleeding was 1600 ml in group A, 1200 ml in group B, and 1000 ml in group C (p < 0.05 vs. group A). Median postoperative stay was comparable in all groups (8-9 days). Operation time was 542 min in group A and 464 min in group B (p < 0.01). Mortality after 30 days and 1, 2, and 5 years was similar in all groups. CONCLUSION Perioperative outcome and long-term survival did not differ when comparing liver resection for CRC liver metastases preceded by PVE and chemotherapy or chemotherapy alone, except for the operation time. The study supports the safety of this "aggressive" combination approach in patients in need of tumor "downstaging" by chemotherapy and PVE to increase the remnant liver volume.
Collapse
Affiliation(s)
- Lidewij Spelt
- Department of Surgery, Clinical Sciences Lund, Skåne University Hospital Lund and Lund University, Lund, Sweden
| | | | | | | | | |
Collapse
|
|
29
|
Simoneau E, Aljiffry M, Salman A, Abualhassan N, Cabrera T, Valenti D, El Baage A, Jamal M, Kavan P, Al-Abbad S, Chaudhury P, Hassanain M, Metrakos P. Portal vein embolization stimulates tumour growth in patients with colorectal cancer liver metastases. HPB (Oxford) 2012; 14:461-8. [PMID: 22672548 PMCID: PMC3384876 DOI: 10.1111/j.1477-2574.2012.00476.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Portal vein embolization (PVE) can facilitate the resection of previously unresectable colorectal cancer (CRC) liver metastases. Bevacizumab is being used increasingly in the treatment of metastatic CRC, although data regarding its effect on post-embolization liver regeneration and tumour growth are conflicting. The objective of this observational study was to assess the impact of pre-embolization bevacizumab on liver hypertrophy and tumour growth. METHODS Computed tomography scans before and 4 weeks after PVE were evaluated in patients who received perioperative chemotherapy with or without bevacizumab. Scans were compared with scans obtained in a control group in which no PVE was administered. Future liver remnant (FLR), total liver volume (TLV) and total tumour volume (TTV) were measured. Bevacizumab was discontinued ≥ 4 weeks before PVE. RESULTS A total of 109 patients and 11 control patients were included. Portal vein embolization induced a significant increase in TTV: the right lobe increased by 33.4% in PVE subjects but decreased by 34.8% in control subjects (P < 0.001), and the left lobe increased by 49.9% in PVE subjects and decreased by 33.2% in controls (P= 0.022). A total of 52.8% of the study group received bevacizumab and 47.2% did not. There was no statistical difference between the two chemotherapy groups in terms of tumour growth. Median FLR after PVE was similar in both groups (28.8% vs. 28.7%; P= 0.825). CONCLUSIONS Adequate liver regeneration was achieved in patients who underwent PVE. However, significant tumour progression was also observed post-embolization.
Collapse
Affiliation(s)
- Eve Simoneau
- Section of Solid Organ Transplant and Hepatopancreatobiliary Surgery, McGill University Health CenterMontreal, QC, Canada
| | - Murad Aljiffry
- Section of Solid Organ Transplant and Hepatopancreatobiliary Surgery, McGill University Health CenterMontreal, QC, Canada,Department of Surgery, College of Medicine, King Abdul Aziz UniversityJeddah, Saudi Arabia
| | - Ayat Salman
- Section of Solid Organ Transplant and Hepatopancreatobiliary Surgery, McGill University Health CenterMontreal, QC, Canada
| | - Nasser Abualhassan
- Section of Solid Organ Transplant and Hepatopancreatobiliary Surgery, McGill University Health CenterMontreal, QC, Canada
| | - Tatiana Cabrera
- Department of Radiology, McGill University Health CenterMontreal, QC, Canada
| | - David Valenti
- Department of Radiology, McGill University Health CenterMontreal, QC, Canada
| | - Arwa El Baage
- Department of Surgery, College of Medicine, King Saud UniversityRiyadh, Saudi Arabia
| | - Mohammad Jamal
- Section of Solid Organ Transplant and Hepatopancreatobiliary Surgery, McGill University Health CenterMontreal, QC, Canada
| | - Petr Kavan
- Department of Oncology, McGill University Health CenterMontreal, QC, Canada
| | - Saleh Al-Abbad
- Section of Solid Organ Transplant and Hepatopancreatobiliary Surgery, McGill University Health CenterMontreal, QC, Canada
| | - Prosanto Chaudhury
- Section of Solid Organ Transplant and Hepatopancreatobiliary Surgery, McGill University Health CenterMontreal, QC, Canada
| | - Mazen Hassanain
- Section of Solid Organ Transplant and Hepatopancreatobiliary Surgery, McGill University Health CenterMontreal, QC, Canada,Department of Surgery, College of Medicine, King Saud UniversityRiyadh, Saudi Arabia
| | - Peter Metrakos
- Section of Solid Organ Transplant and Hepatopancreatobiliary Surgery, McGill University Health CenterMontreal, QC, Canada,Department of Surgery, College of Medicine, King Saud UniversityRiyadh, Saudi Arabia
| |
Collapse
|
|
30
|
Homayounfar K, Bleckmann A, Conradi LC, Sprenger T, Beissbarth T, Lorf T, Niessner M, Sahlmann CO, Meller J, Becker H, Liersch T, Ghadimi BM. Bilobar spreading of colorectal liver metastases does not significantly affect survival after R0 resection in the era of interdisciplinary multimodal treatment. Int J Colorectal Dis 2012; 27:1359-67. [PMID: 22430890 PMCID: PMC3449057 DOI: 10.1007/s00384-012-1455-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Bilobar colorectal liver metastases (CRLM) are often considered incurable or associated with poor prognosis even after R0 resection. In this single-center study, we evaluate the impact of CRLM spreading on recurrence-free survival (RFS) and cancer-specific overall survival (CSS) after R0 resection of CRLM with respect to multimodal treatment strategies including perioperative chemotherapy and multistep resections. METHODS Between January 2001 and December 2010, R0 resection could be achieved in 70 patients with bilobar and 100 with unilobar CRLM. Extent of disease, perioperative chemotherapy, surgical procedures, adjuvant treatment, histopathological workup, RFS, and CSS were compared between both cohorts. RESULTS Forty-six (66 %) patients with bilobar and 26 (26 %) patients with unilobar CRLM received preoperative chemotherapy (p < 0.001). For bilobar CRLM, more extended and multistep resection including portal vein occlusion were performed (29 % versus 3 %; p < 0.001). Morbidity (39 % versus 28 %, p = 0.183) and mortality (1 % versus 3 %, p = 0.644) rates were comparable in both patients' cohorts. Postoperative therapy was applied in adjuvant intent to 42 (60 %) versus 51 (51 %) patients (p = 0.275). The 5-year RFS and CSS rates were 24 % versus 31 % (p = 0.169) and 42 % versus 55 % (p = 0.131), respectively. CONCLUSIONS To our single-center experience, there is no significant effect of CRLM spreading (bilobar versus unilobar) on RFS and CSS rates. Bilobar CRLM are more likely to require extended multimodal efforts to achieve R0 resection.
Collapse
Affiliation(s)
- K. Homayounfar
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - A. Bleckmann
- Department of Hematology and Oncology, University Medical Center, Georg August University Göttingen, Göttingen, Germany ,Department of Medical Statistics, University Medical Center, Georg August University Göttingen, Göttingen, Germany
| | - L. C. Conradi
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - T. Sprenger
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - T. Beissbarth
- Department of Medical Statistics, University Medical Center, Georg August University Göttingen, Göttingen, Germany
| | - T. Lorf
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - M. Niessner
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - C. O. Sahlmann
- Department of Nuclear Medicine, University Medical Center, Georg August University Göttingen, Göttingen, Germany
| | - J. Meller
- Department of Nuclear Medicine, University Medical Center, Georg August University Göttingen, Göttingen, Germany
| | - H. Becker
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - T. Liersch
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - B. M. Ghadimi
- Department of General and Visceral Surgery, University Medical Center, Georg August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| |
Collapse
|
|
31
|
Wang Y, Zheng C, Liang B, Zhao H, Qian J, Liang H, Feng G. Hepatocellular necrosis, apoptosis, and proliferation after transcatheter arterial embolization or chemoembolization in a standardized rabbit model. J Vasc Interv Radiol 2011; 22:1606-12. [PMID: 21959058 DOI: 10.1016/j.jvir.2011.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/23/2011] [Accepted: 08/04/2011] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the effect of transcatheter arterial chemoembolization versus transcatheter arterial embolization on hepatocellular damage, apoptosis, proliferation, and proinflammatory response in a rabbit VX2 tumor model. MATERIALS AND METHODS Rabbits implanted with VX2 tumors in left liver lobes were randomly divided into three groups: a control group (n = 9) that underwent infusion of distilled water into the left hepatic artery, an embolization group (n = 15) that underwent left hepatic artery embolization with polyvinyl alcohol (PVA) particles, and a chemoembolization group (n = 15) that underwent left hepatic artery infusion of a mixture of 10-hydroxycamptothecin and iodized oil followed by PVA embolization. Serum and liver samples were collected at 6 hours, 3 days, and 7 days postoperatively. Liver damage was measured by liver function tests and histologic analysis. Ki-67 immunohistochemistry and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling were performed to quantify proliferating and apoptotic cells. Serum tumor necrosis factor (TNF)-α levels were measured to assess proinflammatory response. RESULTS Compared with embolization, chemoembolization caused liver injury with a greater increase in serum alanine aminotransferase and aspartate aminotransferase levels on days 3 and 7; histologic analysis showed increased hepatic necrosis in adjacent liver tissue beginning at day 3 and increased serum levels of TNF-α at 6 hours. By contrast, chemoembolization resulted in a slower increase in hepatocyte proliferation. Additionally, increased apoptotic hepatocytes were observed after embolization and chemoembolization. CONCLUSIONS In contrast to embolization, nonsuperselective transcatheter arterial chemoembolization increased hepatocellular damage and stimulated systemic proinflammatory cytokine release, but inhibited hepatocyte proliferation.
Collapse
Affiliation(s)
- Yong Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jie-fang Rd., Wuhan 430022, China
| | | | | | | | | | | | | |
Collapse
|
|
32
|
Abstract
BACKGROUND Despite major advances in therapies for liver metastases, colorectal cancer remains one of the commonest causes of cancer-related deaths in the UK. SOURCES OF DATA The international literature on the management of colorectal liver metastases (CLM) was reviewed. AREAS OF AGREEMENT Due to a combination of highly active systemic agents and low perioperative mortality achieved by high-volume centres, a growing number of patients are being offered liver resection with curative intent. Patients with bilobar and/or extrahepatic disease who would previously have received palliative treatment only, are undergoing major surgery with good results. This review focuses on preoperative evaluation, surgical planning and the role of adjuvant therapies in the management of patients with CLM. AREAS OF CONTROVERSY Can ablative therapies match the outcomes of surgical resection? How can even more patients be rendered resectable? GROWING POINTS The use of other therapies, such as radiofrequency ablation and selective internal radiation therapy. AREAS TIMELY FOR DEVELOPING RESEARCH New chemotherapy regimens for neo-adjuvant therapy and the development of new modalities of liver tumour ablation.
Collapse
|
|
33
|
Ratti F, Soldati C, Catena M, Paganelli M, Ferla G, Aldrighetti L. Role of portal vein embolization in liver surgery: single centre experience in sixty-two patients. Updates Surg 2010; 62:153-9. [PMID: 21116886 DOI: 10.1007/s13304-010-0033-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 11/19/2010] [Indexed: 12/17/2022]
Abstract
The extent of liver resection is limited by the residual functional reserve of the liver (FLR). The introduction of portal vein embolization (PVE), with the rationale of inducing hypertrophy of the FLR has significantly reduced morbidity and in particular the impact of postoperative liver failure (PLF). The objective of the study is to evaluate the feasibility and effectiveness of PVE in patients candidates to liver resections with high risk of PLF. Between January 2006 and December 2009, 62 patients suffering from primary or metastatic liver tumour, underwent PVE at the Department of Surgery-Liver Unit HSR. CT assessment of hepatic volume was performed in each patient, prior and 4 weeks after the procedure. The outcome was evaluated in terms of feasibility of surgery, FLR growth [calculated as: (FLR after PVE - FLR pre PVE) × 100/FLR pre PVE], morbidity and mortality associated with PVE and surgery. Of the 62 patients undergoing PVE, 6 (9.7%) did not benefit from surgery: of these, 4 showed spread of disease in the FLR at CT control, while in the remaining 2 adequate hypertrophy was not reached. The average volume of the FLR at the time of the procedure and after 4 weeks was 437.03 cc (±172.54) and 615.15 cc (± 187.49), respectively, with an average increase of 50.3% (±30.31). During the postoperative period, only 2 patients (3.2%) showed mild and transient signs of the PLF. The technique of PVE allows to performing, in an effective and safe way, major liver resections in patients with high risk of PLF.
Collapse
Affiliation(s)
- Francesca Ratti
- Dipartimento di Chirurgia Generale e Specialistica, Unità Operativa Complessa Chirurgia Epatobiliare, Liver Unit, IRCCS H San Raffaele, Università Vita-Salute S. Raffaele, Via Olgettina 60, 20132, Milan, Italy,
| | | | | | | | | | | |
Collapse
|
|
34
|
Clavien PA, Oberkofler CE, Raptis DA, Lehmann K, Rickenbacher A, El-Badry AM. What is critical for liver surgery and partial liver transplantation: size or quality? Hepatology 2010; 52:715-29. [PMID: 20683967 DOI: 10.1002/hep.23713] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Pierre-Alain Clavien
- Swiss Hepato-Pancreatico-Biliary and Transplantation Center, Department of Surgery, University of Zurich, Zurich, Switzerland.
| | | | | | | | | | | |
Collapse
|