Top

Published in:

01-07-2017 | Original Scientific Report

Combined Preoperative Portal and Hepatic Vein Embolization (Biembolization) to Improve Liver Regeneration Before Major Liver Resection: A Preliminary Report

Authors: Bertrand Le Roy, Antoine Perrey, Mikael Fontarensky, Johan Gagnière, Armand Abergel, Bruno Pereira, Celine Lambert, Louis Boyer, Denis Pezet, Pascal Chabrot, Emmanuel Buc

Published in: World Journal of Surgery | Issue 7/2017

Abstract

Background

Insufficient volume of the future liver remnant (FLR) is a major cause of non-resectable disease in patients presenting with primary or metastatic liver tumours. The objective of this study was to evaluate the safety and efficacy of the combined preoperative portal and hepatic vein embolization (biembolization) before extended right liver resections.

Methods

This retrospective study was performed in a tertiary centre between 2014 and 2015. Combined right portal and hepatic vein embolization (biembolization) was proposed, as an alternative to ALPPS procedure, for all patients with primary or metastatic liver tumour, before right extended hepatectomy. CT scan liver volumetry was assessed before biembolization, three weeks after biembolization and one week after surgery.

Results

Seven patients underwent biembolization. All patients had right portal vein embolization (PVE) combined with right hepatic vein embolization (HVE, n = 4), median HVE (n = 2) and right + median HVE (n = 1). Three patients had preoperative liver disease and two received preoperative chemotherapy. No biembolization procedure-related complications occurred. The mean FLR regeneration rate was 52.6% (range: 18.2–187.9) after the biembolization. One patient with gallbladder carcinoma was not operated because of peritoneal carcinomatosis diagnosed after the biembolization. The remnant six patients did not develop postoperative liver failure.

Conclusions

Biembolization seems to induce safe, reproducible and effective FLR growth before extended right hepatectomy, in patients with primary or metastatic liver tumour.

Allen PJ, Jarnagin WR (2003) Current status of hepatic resection. Adv Surg 37:29–49PubMed

Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724CrossRefPubMed

Bruix J, Sherman M, Practice Guidelines Committee et al (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236CrossRefPubMed

Schreckenbach T, Liese J, Bechstein WO et al (2012) Posthepatectomy liver failure. Dig Surg 29:79–85CrossRefPubMed

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

Adam R, Laurent A, Azoulay D et al (2000) Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 232:777–785CrossRefPubMedPubMedCentral

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

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

Vyas SJ, Davies N, Grant L et al (2014) Failure of portal venous embolization. ALPPS as salvage enabling successful resection of bilobar liver metastases. J Gastrointest Cancer 45(Suppl 1):233–236CrossRefPubMed

10.

Abulkhir A, Limongelli P, Healey AJ et al (2008) Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg 247:49–57CrossRefPubMed

11.

Wakabayashi H, Ishimura K, Okano K et al (2002) Application of preoperative portal vein embolization before major hepatic resection in patients with normal or abnormal liver parenchyma. Surgery 131:26–33CrossRefPubMed

12.

De Baere T, Teriitehau C, Deschamps F et al (2010) Predictive factors for hypertrophy of the future remnant liver after selective portal vein embolization. Ann Surg Oncol 17:2081–2089CrossRefPubMed

13.

Shindoh J, Vauthey JN, Zimmitti G et al (2013) Analysis of the efficacy of portal vein embolization for patients with extensive liver malignancy and very low future liver remnant volume, including a comparison with the associating liver partition with portal vein ligation for staged hepatectomy approach. J Am Coll Surg 217:126–133CrossRefPubMed

14.

Schnitzbauer AA, Lang SA, Goessmann H et al (2012) Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 255:405–414CrossRefPubMed

15.

Hwang S, Lee S-G, Ko G-Y et al (2009) Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg 249:608–616CrossRefPubMed

16.

Van Lienden KP, van den Esschert JW, Rietkerk M et al (2012) Short-term effects of combined hepatic vein embolization and portal vein embolization for the induction of liver regeneration in a rabbit model. J Vasc Interv Radiol 23:962–967CrossRefPubMed

17.

Guiu B, Chevallier P, Denys A et al (2016) Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol 26(12):4259–4267CrossRefPubMed

18.

Le Roy B, Gagnière J, Chabrot P et al (2016) Non-lethal right liver atrophy after TIPS occlusion in A Cirrhotic patient: introducing the hepatic biembolization. J Gastrointest Surg 20(9):1671–1672CrossRefPubMed

19.

Takagi T, Yokoyama Y, Kokuryo T, Ebata T, Ando M, Nagino M (2016) A clear difference between the outcomes after a major hepatectomy with and without an extrahepatic bile duct resection. World J Surg. doi:10.1007/s00268-016-3744-2 PubMed

20.

Kishi Y, Zorzi D, Contreras CM et al (2010) Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases. Ann Surg Oncol 17(11):2870–2876CrossRefPubMed

21.

Llovet JM, Fuster J, Bruix J, Barcelona-Clínic Liver Cancer Group (2004) The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl 10(2 Suppl 1):S115–S120CrossRefPubMed

22.

Truant S, Oberlin O, Sergent G et al (2007) Remnant liver volume to body weight ratio > or = 0.5%: a new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg 204(1):22–33CrossRefPubMed

23.

Ogata S, Belghiti J, Farges O, Varma D, Sibert A, Vilgrain V (2006) Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma. Br J Surg 93(9):1091–1098CrossRefPubMed

24.

Allard MA, Adam R, Bucur PO et al (2013) Posthepatectomy portal vein pressure predicts liver failure and mortality after major liver resection on noncirrhotic liver. Ann Surg 258(5):822–829 (discussion 829-30) CrossRefPubMed

25.

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

26.

Balzan S, Belghiti J, Farges O et al (2005) The “50–50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828CrossRefPubMedPubMedCentral

27.

Mullen JT, Ribero D, Reddy SK et al (2007) Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 204:854–862CrossRefPubMed

28.

Denys A, Lacombe C, Schneider F et al (2005) Portal vein embolization with N-butyl cyanoacrylate before partial hepatectomy in patients with hepatocellular carcinoma and underlying cirrhosis or advanced fibrosis. J Vasc Interv Radiol 16:1667–1674CrossRefPubMed

29.

Yokoyama Y, Nagino M, Nimura Y (2007) Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review. World J Surg 31:367–374. doi:10.1007/s00268-006-0526-2 CrossRefPubMed

30.

Kishi Y, Madoff DC, Abdalla EK et al (2008) Is embolization of segment 4 portal veins before extended right hepatectomy justified? Surgery 144:744–751CrossRefPubMed

31.

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

32.

Madoff DC, Abdalla EK, Gupta S et al (2005) Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol 16:215–225CrossRefPubMed

33.

Schadde E, Ardiles V, Slankamenac K et al (2014) ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis. World J Surg 38:1510–1519. doi:10.1007/s00268-014-2513-3 CrossRefPubMed

34.

Torres OJM, de Fernandes ESM, Oliveira CVC et al (2013) Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazilian experience. Arq Bras Cir Dig 26:40–43CrossRefPubMed

35.

Hasselgren K, Sandström P, Björnsson B (2015) Role of associating liver partition and portal vein ligation for staged hepatectomy in colorectal liver metastases: a review. World J Gastroenterol 21:4491–4498PubMedPubMedCentral

36.

Oldhafer KJ, Donati M, Jenner RM et al (2014) ALPPS for patients with colorectal liver metastases: effective liver hypertrophy, but early tumor recurrence. World J Surg 38:1504–1509. doi:10.1007/s00268-013-2401-2 CrossRefPubMed

37.

Dupré A, Hitier M, Peyrat P et al (2015) Associating portal embolization and artery ligation to induce rapid liver regeneration in staged hepatectomy. Br J Surg 102:1541–1550CrossRefPubMed

38.

Niiya T, Murakami M, Aoki T et al (1999) Immediate increase of portal pressure, reflecting sinusoidal shear stress, induced liver regeneration after partial hepatectomy. J Hepatobiliary Pancreat Surg 6:275–280CrossRefPubMed

39.

Balzan SM, Gava VG, Magalhaes MA, Dotto ML (2014) Outflow modulation to target liver regeneration: something old, something new. Eur J Surg Oncol 40(2):140–143CrossRefPubMed

40.

Schoen JM, Wang HH, Minuk GY et al (2001) Shear stress-induced nitric oxide release triggers the liver regeneration cascade. Nitric Oxide 5:453–464CrossRefPubMed

41.

Scatton O, Plasse M, Dondero F et al (2008) Impact of localized congestion related to venous deprivation after hepatectomy. Surgery 143:483–489CrossRefPubMed

42.

Ko GY, Hwang S, Sung KB, Gwon DI, Lee SG (2010) Interventional oncology: new options for interstitial treatments and intravascular approaches: right hepatic vein embolization after right portal vein embolization for inducing hypertrophy of the future liver remnant. J Hepatobiliary Pancreat Sci 17(4):410–412CrossRefPubMed

43.

Wilms C, Mueller L, Lenk C et al (2008) Comparative study of portal vein embolization versus portal vein ligation for induction of hypertrophy of the future liver remnant using a mini-pig model. Ann Surg 247:825–834CrossRefPubMed

44.

Truant S, Baillet C, Deshorgue AC et al (2016) Drop of total liver function in the interstages of the new associating liver partition and portal vein ligation for staged hepatectomy technique: analysis of the “Auxiliary Liver” by HIDA scintigraphy. Ann Surg 263(3):e33–e34CrossRefPubMed

Title: Combined Preoperative Portal and Hepatic Vein Embolization (Biembolization) to Improve Liver Regeneration Before Major Liver Resection: A Preliminary Report
Authors: Bertrand Le Roy
Antoine Perrey
Mikael Fontarensky
Johan Gagnière
Armand Abergel
Bruno Pereira
Celine Lambert
Louis Boyer
Denis Pezet
Pascal Chabrot
Emmanuel Buc
Publication date: 01-07-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4016-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Combined Preoperative Portal and Hepatic Vein Embolization (Biembolization) to Improve Liver Regeneration Before Major Liver Resection: A Preliminary Report

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2017

Refractory Long-Term Cholangitis After Pancreaticoduodenectomy: A Retrospective Study

The Role of 18F-fluorodeoxyglucose Positron Emission Tomography-Computed Tomography for Predicting Pathologic Response After Induction Therapy for Thymic Epithelial Tumors

Survey of Emergency and Essential Surgical, Obstetric and Anaesthetic Services Available in Bangladeshi Government Health Facilities

Surgical Treatment of High-Grade Dysplasia and Early Esophageal Cancer

Pathophysiology of Gastroesophageal Reflux Disease

ISS Symposium From Heartburn to Barrett’s Esophagus, and Beyond