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01-08-2017 | Interventional

Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function

Authors: Boris Guiu, François Quenet, Laure Escal, Frédéric Bibeau, Lauranne Piron, Philippe Rouanet, Jean-Michel Fabre, Eric Jacquet, Alban Denys, Pierre-Olivier Kotzki, Daniel Verzilli, Emmanuel Deshayes

Published in: European Radiology | Issue 8/2017

Abstract

Objective

The aim of this study was to assess the safety and efficacy of extended liver venous deprivation (eLVD), i.e. combination of right portal vein embolisation and right (accessory right) and middle hepatic vein embolisation before major hepatectomy for future remnant liver (FRL) functional increase.

Methods

eLVD was performed in non-cirrhotic patients referred for major hepatectomy in a context of small FRL (baseline FRL <25% of the total liver volume or FRL function <2.69%/min/m²). All patients underwent ^99mTc-mebrofenin hepatobiliary scintigraphy (HBS) and computed tomographic evaluations.

Results

Ten consecutive patients underwent eLVD before surgery for liver metastases (n = 8), Klatskin tumour (n = 1) and gallbladder carcinoma (n = 1). FRL function increased by 64.3% (range = 28.1-107.5%) at day 21. In patients with serial measurements, maximum FRL function was at day 7 (+65.7 ± 16%). The FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day). Thirty-one days (range = 22-45 days) after eLVD, 9/10 patients were resected. No post-hepatectomy liver failure was reported. Two grade II and one grade III complications (Dindo-Clavien classification) occurred. No patient died with-in 90 days following surgery.

Conclusions

eLVD is safe and provides a marked and very rapid increase in liver function, unprecedented for an interventional radiology procedure.

Key Points

• eLVD is safe

• eLVD provides a marked and very rapid increase in liver function

• After eLVD, the FRL-F increased by 64.3% (28.1-107.5%) at day 21

• After eLVD, the maximum FRL-F was obtained at day 7 (+65.7 ± 16%)

• After eLVD, the FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day)

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Title: Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function
Authors: Boris Guiu
François Quenet
Laure Escal
Frédéric Bibeau
Lauranne Piron
Philippe Rouanet
Jean-Michel Fabre
Eric Jacquet
Alban Denys
Pierre-Olivier Kotzki
Daniel Verzilli
Emmanuel Deshayes
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 8/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4744-9

At a glance: The STEP trials

Springer Medicine

Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function

Abstract

Objective

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Key Points

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