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01-07-2016 | Original Article

A Nomogram to Predict Hypertrophy of Liver Segments 2 and 3 After Right Portal Vein Embolization

Authors: Yoshihiro Mise, Guillaume Passot, Xuemei Wang, Hsiang-Chun Chen, Steven Wei, Kristoffer W. Brudvik, Thomas A. Aloia, Claudius Conrad, Steven Y. Huang, Jean-Nicolas Vauthey

Published in: Journal of Gastrointestinal Surgery | Issue 7/2016

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.

Azoulay D, Castaing D, Krissat J, Smail A, Hargreaves GM, Lemoine A, Emile JF, Bismuth H. Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver. Ann Surg 2000;232:665-672.CrossRefPubMedPubMedCentral

Elias D, Ouellet JF, De Baere T, Lasser P, Roche A. Preoperative selective portal vein embolization before hepatectomy for liver metastases: long-term results and impact on survival. Surgery 2002;131:294-299.CrossRefPubMed

Shindoh J, Tzeng CW, Aloia TA, Curley SA, Zimmitti G, Wei SH, Huang SY, Mahvash A, Gupta S, Wallace MJ, Vauthey JN. Optimal future liver remnant in patients treated with extensive preoperative chemotherapy for colorectal liver metastases. Ann Surg Oncol 2013;20:2493-2500.CrossRefPubMed

Kishi Y, Abdalla EK, Chun YS, Zorzi D, Madoff DC, Wallace MJ, Curley SA, Vauthey JN. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg 2009;250:540-548.PubMed

Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, Harihara Y, Takayama T. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 1997;26:1176-1181.PubMed

Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 2006;243:364-372.CrossRefPubMedPubMedCentral

Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nagino M. Portal vein embolization before extended hepatectomy for biliary cancer: current technique and review of 494 consecutive embolizations. Dig Surg 2012;29:23-29.CrossRefPubMed

Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg 2007;94:1386-1394.CrossRefPubMed

Makuuchi M, Thai BL, Takayasu K, Takayama T, Kosuge T, Gunven P, Yamazaki S, Hasegawa H, Ozaki H. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990;107:521-527.PubMed

10.

Shindoh J, Tzeng CW, Aloia TA, Curley SA, Huang SY, Mahvash A, Gupta S, Wallace MJ, Vauthey JN. Safety and Efficacy of Portal Vein Embolization Before Planned Major or Extended Hepatectomy: An Institutional Experience of 358 Patients. J Gastrointest Surg 2013;

11.

Kaido T, Arii S, Shimada Y, Mori A, Imamura M. Portal embolization in various types of liver: novel variables to predict hypertrophy. Hepatogastroenterology 2003;50:140-145.PubMed

12.

Kasai Y, Hatano E, Iguchi K, Seo S, Taura K, Yasuchika K, Mori A, Kaido T, Tanaka S, Shibata T, Uemoto S. Prediction of the remnant liver hypertrophy ratio after preoperative portal vein embolization. Eur Surg Res 2013;51:129-137.CrossRefPubMed

13.

de Baere T, Teriitehau C, Deschamps F, Catherine L, Rao P, Hakime A, Auperin A, Goere D, Elias D, Hechelhammer L. Predictive factors for hypertrophy of the future remnant liver after selective portal vein embolization. Ann Surg Oncol 2010;17:2081-2089.CrossRefPubMed

14.

Okabe H, Beppu T, Nakagawa S, Yoshida M, Hayashi H, Masuda T, Imai K, Mima K, Kuroki H, Nitta H, Hashimoto D, Chikamoto A, Ishiko T, Watanabe M, Yamashita Y, Baba H. Percentage of future liver remnant volume before portal vein embolization influences the degree of liver regeneration after hepatectomy. J Gastrointest Surg 2013;17:1447-1451.CrossRefPubMed

15.

Tanaka K, Kumamoto T, Matsuyama R, Takeda K, Nagano Y, Endo I. Influence of chemotherapy on liver regeneration induced by portal vein embolization or first hepatectomy of a staged procedure for colorectal liver metastases. J Gastrointest Surg 2010;14:359-368.CrossRefPubMed

16.

Vauthey JN, Pawlik TM, Abdalla EK, Arens JF, Nemr RA, Wei SH, Kennamer DL, Ellis LM, Curley SA. Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg 2004;239:722-730.CrossRefPubMedPubMedCentral

17.

Kishi Y, Madoff DC, Abdalla EK, Palavecino M, Ribero D, Chun YS, Vauthey JN. Is embolization of segment 4 portal veins before extended right hepatectomy justified? Surgery 2008;144:744-751.CrossRefPubMed

18.

Madoff DC, Abdalla EK, Gupta S, Wu TT, Morris JS, Denys A, Wallace MJ, Morello FA, Jr., Ahrar K, Murthy R, Lunagomez S, Hicks ME, Vauthey JN. Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol 2005;16:215-225.CrossRefPubMed

19.

Brouquet A, Abdalla EK, Kopetz S, Garrett CR, Overman MJ, Eng C, Andreou A, Loyer EM, Madoff DC, Curley SA, Vauthey JN. High survival rate after two-stage resection of advanced colorectal liver metastases: response-based selection and complete resection define outcome. J Clin Oncol 2011;29:1083-1090.CrossRefPubMedPubMedCentral

20.

Vauthey JN, Abdalla EK, Doherty DA, Gertsch P, Fenstermacher MJ, Loyer EM, Lerut J, Materne R, Wang X, Encarnacion A, Herron D, Mathey C, Ferrari G, Charnsangavej C, Do KA, Denys A. Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 2002;8:233-240.CrossRefPubMed

21.

FR H. Regression Modeling Strategies: With Applications to linear Models, Logistic Regression, and Survival Analysis. New York, Springer 2001;

22.

Nagino M, Kamiya J, Kanai M, Uesaka K, Sano T, Yamamoto H, Hayakawa N, Nimura Y. Right trisegment portal vein embolization for biliary tract carcinoma: technique and clinical utility. Surgery 2000;127:155-160.CrossRefPubMed

23.

Mise Y, Aloia TA, Conrad C, Huang SY, Wallace MJ, Vauthey JN. Volume Regeneration of Segments 2 and 3 After Right Portal Vein Embolization in Patients Undergoing Two-Stage Hepatectomy. J Gastrointest Surg 2014;

24.

Ouaissi M, Gaujoux S, Veyrie N, Deneve E, Brigand C, Castel B, Duron JJ, Rault A, Slim K, Nocca D. Post-operative adhesions after digestive surgery: their incidence and prevention: review of the literature. J Visc Surg 2012;149:e104-114.CrossRefPubMed

25.

Shimizu A, Suhara T, Ito T, Omichi K, Naruse K, Hasegawa K, Kokudo N. New hepatectomy-induced postoperative adhesion model in rats, and evaluation of the efficacy of anti-adhesion materials. Surg Today 2014;44:314-323.CrossRefPubMed

26.

Dupre A, Lefranc A, Buc E, Delpero JR, Quenet F, Passot G, Evrard S, Rivoire M. Use of bioresorbable membranes to reduce abdominal and perihepatic adhesions in 2-stage hepatectomy of liver metastases from colorectal cancer: results of a prospective, randomized controlled phase II trial. Ann Surg 2013;258:30-36.CrossRefPubMed

27.

Giraudo G, Greget M, Oussoultzoglou E, Rosso E, Bachellier P, Jaeck D. Preoperative contralateral portal vein embolization before major hepatic resection is a safe and efficient procedure: a large single institution experience. Surgery 2008;143:476-482.CrossRefPubMed

28.

Goere D, Farges O, Leporrier J, Sauvanet A, Vilgrain V, Belghiti J. Chemotherapy does not impair hypertrophy of the left liver after right portal vein obstruction. J Gastrointest Surg 2006;10:365-370.CrossRefPubMed

29.

Covey AM, Brown KT, Jarnagin WR, Brody LA, Schwartz L, Tuorto S, Sofocleous CT, D’Angelica M, Getrajdman GI, DeMatteo R, Kemeny NE, Fong Y. Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases. Ann Surg 2008;247:451-455.CrossRefPubMed

30.

Zorzi D, Chun YS, Madoff DC, Abdalla EK, Vauthey JN. Chemotherapy with bevacizumab does not affect liver regeneration after portal vein embolization in the treatment of colorectal liver metastases. Ann Surg Oncol 2008;15:2765-2772.CrossRefPubMed

31.

Kishi Y, Zorzi D, Contreras CM, Maru DM, Kopetz S, Ribero D, Motta M, Ravarino N, Risio M, Curley SA, Abdalla EK, Capussotti L, Vauthey JN. Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases. Ann Surg Oncol 2010;17:2870-2876.CrossRefPubMed

32.

Lehmann K, Rickenbacher A, Weber A, Pestalozzi BC, Clavien PA. Chemotherapy before liver resection of colorectal metastases: friend or foe? Ann Surg 2012;255:237-247.CrossRefPubMed

33.

Shindoh J, Truty MJ, Aloia TA, Curley SA, Zimmitti G, Huang SY, Mahvash A, Gupta S, Wallace MJ, Vauthey JN. Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant. J Am Coll Surg 2013;216:201-209.CrossRefPubMed

Title: A Nomogram to Predict Hypertrophy of Liver Segments 2 and 3 After Right Portal Vein Embolization
Authors: Yoshihiro Mise
Guillaume Passot
Xuemei Wang
Hsiang-Chun Chen
Steven Wei
Kristoffer W. Brudvik
Thomas A. Aloia
Claudius Conrad
Steven Y. Huang
Jean-Nicolas Vauthey
Publication date: 01-07-2016
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 7/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-016-3145-8

At a glance: The STEP trials

Springer Medicine

A Nomogram to Predict Hypertrophy of Liver Segments 2 and 3 After Right Portal Vein Embolization

Abstract

Background

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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