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Journal of Gastrointestinal Surgery

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01-01-2015 | 2014 SSAT Plenary Presentation

Volume Regeneration of Segments 2 and 3 After Right Portal Vein Embolization in Patients Undergoing Two-Stage Hepatectomy

Authors: Yoshihiro Mise, Thomas A. Aloia, Claudius Conrad, Steven Y. Huang, Michael J. Wallace, Jean-Nicolas Vauthey

Published in: Journal of Gastrointestinal Surgery | Issue 1/2015

Abstract

Background

The impact of first-stage resection on volume regeneration of segments 2 and 3 (2 + 3) after right portal vein embolization (RPVE) in patients undergoing two-stage right hepatectomy has not been investigated.

Method

Volume data for segments 2 + 3 were compared between 44 patients undergoing two-stage hepatectomy and 116 undergoing single-stage hepatectomy after RPVE.

Results

The degree of hypertrophy (difference between standardized volume of segments 2 + 3 before and after RPVE) and kinetic growth rate (degree of hypertrophy at initial volume assessment divided by the number of weeks elapsed after RPVE) were significantly lower in patients undergoing two-stage hepatectomy (median 8.6 vs 10.5 % [p = 0.01] and 1.7 vs 2.4 % [p < 0.01], respectively). Resection volume during first-stage resection was negatively correlated with standardized volume increase from the volume before first-stage resection (R ² 0.546, p < 0.01). In patients undergoing two-stage hepatectomy after RPVE with segment 4 embolization, the degree of hypertrophy and kinetic growth rate were similar to those in patients undergoing single-stage hepatectomy (p = 0.17 and p = 0.08, respectively).

Conclusion

In patients undergoing two-stage hepatectomy, first-stage resection impairs the dynamics of volume regeneration of segments 2 + 3 after RPVE. When two-stage extended right hepatectomy is planned, additional embolization of segment 4 provides volume hypertrophy similar to that in patients undergoing single-stage hepatectomy.

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;29:1083–90.PubMedCentralPubMedCrossRef

Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, Grothey A, Vauthey JN, Nagorney DM, McWilliams RR. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol 2009;27:3677–83.PubMedCentralPubMedCrossRef

Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H. Two-stage hepatectomy: A planned strategy to treat irresectable liver tumors. Ann Surg 2000;232:777–85.PubMedCentralPubMedCrossRef

Chua TC, Liauw W, Chu F, Morris DL. Summary outcomes of two-stage resection for advanced colorectal liver metastases. J Surg Oncol 2013;107:211–6.PubMedCrossRef

Jaeck D, Bachellier P, Nakano H, Oussoultzoglou E, Weber JC, Wolf P, Greget M. One or two-stage hepatectomy combined with portal vein embolization for initially nonresectable colorectal liver metastases. Am J Surg 2003;185:221–9.PubMedCrossRef

Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P. 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 2004;240:1037–49; discussion 49–51.PubMedCentralPubMedCrossRef

Lam VW, Laurence JM, Johnston E, Hollands MJ, Pleass HC, Richardson AJ. A systematic review of two-stage hepatectomy in patients with initially unresectable colorectal liver metastases. HPB (Oxford) 2013;15:483–91.CrossRef

Schadde E, Slankamenac K, Breitenstein S, Lesurtel M, De Oliveira M, Beck-Schimmer B, Dutkowski P, Clavien PA. Are two-stage hepatectomies associated with more complications than one-stage procedures? HPB (Oxford) 2013;15:411–7.CrossRef

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;144:744–51.PubMedCrossRef

10.

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;127:155–60.PubMedCrossRef

11.

Robles R, Marin C, Lopez-Conesa A, Capel A, Perez-Flores D, Parrilla P. Comparative study of right portal vein ligation versus embolisation for induction of hypertrophy in two-stage hepatectomy for multiple bilateral colorectal liver metastases. Eur J Surg Oncol 2012;38:586–93.PubMedCrossRef

12.

Huang SY, Aloia TA, Shindoh J, Ensor J, Shaw CM, Loyer EM, Vauthey JN, Wallace MJ. Efficacy and Safety of Portal Vein Embolization for Two-Stage Hepatectomy in Patients with Colorectal Liver Metastasis. J Vasc Interv Radiol 2013.

13.

Narita M, Oussoultzoglou E, Jaeck D, Fuchschuber P, Rosso E, Pessaux P, Marzano E, Bachellier P. Two-stage hepatectomy for multiple bilobar colorectal liver metastases. Br J Surg 2011;98:1463–75.PubMedCrossRef

14.

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;216:201–9.PubMedCentralPubMedCrossRef

15.

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;94:1386–94.PubMedCrossRef

16.

Vauthey JN, Lauwers GY, Esnaola NF, Do KA, Belghiti J, Mirza N, Curley SA, Ellis LM, Regimbeau JM, Rashid A, Cleary KR, Nagorney DM. Simplified staging for hepatocellular carcinoma. J Clin Oncol 2002;20:1527–36.PubMedCrossRef

17.

Vauthey JN, Chaoui A, Do KA, Bilimoria MM, Fenstermacher MJ, Charnsangavej C, Hicks M, Alsfasser G, Lauwers G, Hawkins IF, Caridi J. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery 2000;127:512–9.PubMedCrossRef

18.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13.PubMedCentralPubMedCrossRef

19.

Yamanaka N, Okamoto E, Kawamura E, Kato T, Oriyama T, Fujimoto J, Furukawa K, Tanaka T, Tomoda F, Tanaka W. Dynamics of normal and injured human liver regeneration after hepatectomy as assessed on the basis of computed tomography and liver function. Hepatology 1993;18:79–85.PubMedCrossRef

20.

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;17:1447–51.PubMedCrossRef

21.

Nagino M, Ando M, Kamiya J, Uesaka K, Sano T, Nimura Y. Liver regeneration after major hepatectomy for biliary cancer. Br J Surg 2001;88:1084–91.PubMedCrossRef

22.

Tani M, Tomiya T, Yamada S, Hayashi S, Yahata K, Tamura Y, Akiyama M, Kawai S, Masaki N, Fujiwara K, et al. Regulating factors of liver regeneration after hepatectomy. Cancer Chemother Pharmacol 1994;33 Suppl:S29–32.PubMedCrossRef

23.

Kele PG, de Boer M, van der Jagt EJ, Lisman T, Porte RJ. Early hepatic regeneration index and completeness of regeneration at 6 months after partial hepatectomy. Br J Surg 2012;99:1113–9.PubMedCrossRef

24.

Kawasaki S, Makuuchi M, Ishizone S, Matsunami H, Terada M, Kawarazaki H. Liver regeneration in recipients and donors after transplantation. Lancet 1992;339:580–1.PubMedCrossRef

25.

Chen MF, Hwang TL, Hung CF. Human liver regeneration after major hepatectomy. A study of liver volume by computed tomography. Ann Surg 1991;213:227–9.PubMedCentralPubMedCrossRef

26.

Pomfret EA, Pomposelli JJ, Gordon FD, Erbay N, Lyn Price L, Lewis WD, Jenkins RL. Liver regeneration and surgical outcome in donors of right-lobe liver grafts. Transplantation 2003;76:5–10.PubMedCrossRef

27.

Zappa M, Dondero F, Sibert A, Vullierme MP, Belghiti J, Vilgrain V. Liver regeneration at day 7 after right hepatectomy: global and segmental volumetric analysis by using CT. Radiology 2009;252:426–32.PubMed

28.

Haga J, Shimazu M, Wakabayashi G, Tanabe M, Kawachi S, Fuchimoto Y, Hoshino K, Morikawa Y, Kitajima M, Kitagawa Y. Liver regeneration in donors and adult recipients after living donor liver transplantation. Liver Transpl 2008;14:1718–24.PubMedCrossRef

29.

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;17:2081–9.PubMedCrossRef

30.

Bucher NL, Swaffield MN. THE RATE OF INCORPORATION OF LABELED THYMIDINE INTO THE DEOXYRIBONUCLEIC ACID OF REGENERATING RAT LIVER IN RELATION TO THE AMOUNT OF LIVER EXCISED. Cancer Res 1964;24:1611–25.PubMed

31.

Massimino KP, Kolbeck KJ, Enestvedt CK, Orloff S, Billingsley KG. Safety and efficacy of preoperative right portal vein embolization in patients at risk for postoperative liver failure following major right hepatectomy. HPB (Oxford) 2012;14:14–9.CrossRef

32.

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;16:215–25.PubMedCrossRef

33.

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;51:129–37.PubMedCrossRef

34.

Kaido T, Arii S, Shimada Y, Mori A, Imamura M. Portal embolization in various types of liver: novel variables to predict hypertrophy. Hepatogastroenterology 2003;50:140–5.PubMed

Title: Volume Regeneration of Segments 2 and 3 After Right Portal Vein Embolization in Patients Undergoing Two-Stage Hepatectomy
Authors: Yoshihiro Mise
Thomas A. Aloia
Claudius Conrad
Steven Y. Huang
Michael J. Wallace
Jean-Nicolas Vauthey
Publication date: 01-01-2015
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 1/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2617-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Volume Regeneration of Segments 2 and 3 After Right Portal Vein Embolization in Patients Undergoing Two-Stage Hepatectomy

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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