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1.
Thierry de Baere Christophe Teriitehau Frederic Deschamps Laurence Catherine Pramod Rao Antoine Hakime Anne Auperin Diane Goere Dominique Elias Lukas Hechelhammer 《Annals of surgical oncology》2010,17(8):2081-2089
Background
To analyze predictive factors of hypertrophy of the nonembolized future remnant liver (FRL) after transhepatic preoperative portal vein embolization (PVE) of the liver to be resected. 相似文献2.
Narita M Oussoultzoglou E Chenard MP Fuchshuber P Rosso E Pessaux P Jaeck D Bachellier P 《Journal of gastrointestinal surgery》2012,16(3):554-561
Background
The adverse oncological effect of portal vein embolization (PVE) in patients with colorectal liver metastases (CLM) remains controversial. This study was designed to evaluate the effect of PVE on change of tumor characteristics using tumor specimens obtained from sequential hepatectomy before and after PVE. 相似文献3.
Jacomina W. van den Esschert Wilmar de Graaf Krijn P. van Lienden Olivier R. Busch Michal Heger Otto M. van Delden Dirk J. Gouma Roelof J. Bennink Johan S. Laméris Thomas M. van Gulik 《Journal of gastrointestinal surgery》2009,13(8):1464-1469
Introduction Portal vein embolization is an accepted method to increase the future remnant liver preoperatively. The aim of this study
was to assess the effect of preoperative portal vein embolization on liver volume and function 3 months after major liver
resection.
Materials and methods This is a retrospective case-control study. Data were collected of patients who underwent portal vein embolization prior to
(extended) right hemihepatectomy and of control patients who underwent the same type of resection without prior portal vein
embolization. Liver volumes were measured by computed tomography volumetry before portal vein embolization, before liver resection,
and 3 months after liver resection. Liver function was assessed by hepatobiliary scintigraphy before and 3 months after liver
resection.
Results Ten patients were included in the embolization group and 13 in the control group. Groups were comparable for gender, age,
and number of patients with a compromised liver. The mean future remnant liver volume was 33.0 ± 8.0% prior to portal vein
embolization in the embolization group and 45.6 ± 9.1% in the control group (p < 0.01). Prior to surgery, there were no significant differences in future remnant liver volume and function between the
groups. Three months postoperatively, the mean remnant liver volume was 81.9 ± 8.9% of the initial total liver volume in the
embolization group and 79.4 ± 11.0% in the control group (p > 0.05). Remnant liver function increased up to 88.1 ± 17.4% and 83.3 ± 14% respectively of the original total liver function
(p > 0.05).
Conclusion Preoperative portal vein embolization does not negatively influence postoperative liver regeneration assessed 3 months after
major liver resection.
No grant support.
Paper presented at the SSAT, Chicago, June 1, 2009. 相似文献
4.
Suguru Yamashita Kiyoshi Hasegawa Michiro Takahashi Yosuke Inoue Yoshihiro Sakamoto Taku Aoki Yasuhiko Sugawara Norihiro Kokudo 《World journal of surgery》2013,37(3):622-628
Background
Although portal vein embolization (PVE) has been applied for surgical resection of colorectal liver metastases (CLM), the clinical usefulness of liver surgery following PVE for CLM remains unknown.Methods
A total of 115 patients were evaluated retrospectively. Among them, 49 underwent one-stage hepatectomy following PVE (PVE group). The remaining 66 patients underwent at least hemihepatectomy without PVE (non-PVE group). This analysis compared the short- and long-term outcomes between the PVE and non-PVE groups.Results
There were no deaths in either group. Using the Clavien–Dindo classification, the rates of postoperative morbidity ≥ grade 1 were 34.7 % in the PVE group and 25.0 % in the non-PVE group (p = 0.26). The 3-year overall survival rates were 54.6 and 64.5 % in the PVE and non-PVE groups, respectively (p = 0.89). The multivariate analysis the variable performance/nonperformance of PVE was not detected as an independent predictor of poor survival.Conclusions
Our one-stage hepatectomy policy of using PVE provides acceptable morbidity and favorable long-term outcomes. 相似文献5.
Fernando Rotellar MD PhD Fernando Pardo MD Alberto Benito MD PhD Pablo Martí-Cruchaga MD Gabriel Zozaya MD Manuel Bellver MD 《Annals of surgical oncology》2014,21(1):165-166
Background
Laparoscopic right hepatectomy (LRH) is a complex but feasible procedure. Preoperative portal vein embolization (PVE) can add difficulties that warrant particular technical modifications. A LRH extended to middle hepatic vein after PVE is presented, with special attention paid to specific operative findings and to useful technical modifications.Methods
A 62-year-old female patient with a body mass index of 30.5 kg/m2 was diagnosed with a 3-cm unresectable centrally located intrahepatic cholangiocarcinoma with infiltration of the retrohepatic vena cava, segment VII portal branch, and adjacent to the middle hepatic vein and portal bifurcation. After four cycles of GEMOX, partial response was observed, disappearing vascular infiltration. PVE was required to perform an extended LRH. Consequently, during pedicle dissection, significant inflammation was found in the vicinity of the right portal vein. Thus, the section of the portal and biliary elements was delayed until the transection of the parenchyma reached the hilum. The opening of the parenchyma improved exposure, allowing the safe management of these structures individually.Results
The total operative time was 438 min. Three periods of 15-min pedicle occlusion resulted in <100 ml bleeding. Hospital stay was 4 days. Pathological examination revealed residual cholangiocarcinoma with intense posttreatment changes (pT1) and tumor-free margins. After an 18-month follow-up, the patient was alive and free of disease.Conclusions
LRH is feasible and safe, even after PVE. Nevertheless, periportal inflammation can hinder hilar dissection. In this setting, delaying section of portal and biliary elements until parenchymal transection reaches the hilar region may result in a useful and safe strategy. 相似文献6.
Shohei Yoshiya Ken Shirabe Hidekazu Nakagawara Yuji Soejima Tomoharu Yoshizumi Toru Ikegami Yo-ichi Yamashita Norifumi Harimoto Akihiro Nishie Takeharu Yamanaka Yoshihiko Maehara 《World journal of surgery》2014,38(6):1491-1497
Background
Although various complications after hepatectomy have been reported, there have been no large studies on postoperative portal vein thrombosis (PVT) as a complication. This study evaluated the incidence, risk factors, and clinical outcomes of PVT after hepatectomy.Methods
The preoperative and postoperative clinical characteristics of patients who underwent hepatectomy were retrospectively analyzed.Results
A total of 208 patients were reviewed. The incidence of PVT after hepatectomy was 9.1 % (n = 19), including main portal vein (MPV) thrombosis (n = 7) and peripheral portal vein (PPV) thrombosis (n = 12). Patients with MPV thrombosis had a significantly higher incidence of right hepatectomy (p < 0.001), larger resection volume (p = 0.003), and longer operation time (p = 0.021) than patients without PVT (n = 189). Multivariate analysis identified right hepatectomy as a significant independent risk factor for MPV thrombosis (odds ratio 108.9; p < 0.001). Patients with PPV thrombosis had a significantly longer duration of Pringle maneuver than patients without PVT (p = 0.002). Among patients who underwent right hepatectomy, those with PVT (n = 6) had a significantly lower early liver regeneration rate than those without PVT (n = 13; p = 0.040), and those with PVT had deterioration of liver function on postoperative day 7. In all patients with MPV thrombosis who received anticoagulation therapy, PVT subsequently resolved.Conclusions
Postoperative PVT after hepatectomy is not rare. It is closely related to delayed recovery of liver function and delayed liver regeneration. 相似文献7.
8.
B. Aussilhou M. Lesurtel A. Sauvanet O. Farges S. Dokmak N. Goasguen A. Sibert V. Vilgrain J. Belghiti 《Journal of gastrointestinal surgery》2008,12(2):297-303
Background Aim of this retrospective study was to compare induction of left liver hypertrophy after right portal vein ligation (PVL)
and right portal vein embolization (PVE) before right hepatectomy for liver metastases.
Materials and Methods Between 1998 and 2005, 18 patients underwent a PVE, whereas 17 patients underwent a PVL during a first stage laparotomy.
Results There was no complication related to PVE or PVL. After a similar interval time (7 ± 3 vs 8 ± 3 weeks), the increase of the
left liver volume was similar between the two groups (35 ± 38 vs 38 ± 26%). After PVE and PVL, right hepatectomy was performed
in 12 and 14 patients, respectively. Technical difficulties during the right hepatectomy were similar according to duration
of procedure (6.4 ± 1 vs 6.7 ± 1 h, p = 0.7) and transfusion rates (33 vs 28%, p = 0.7). Mortality was nil in both groups, and morbidity rates were respectively 58% for the PVE group and 36% for the PVL
group (p = 0.6).
Conclusion Right PVL and PVE result in a comparable hypertrophy of the left liver. During the first laparotomy of a two-step liver resection,
PVL can be efficiently and safely performed. 相似文献
9.
Chemotherapy With Bevacizumab Does Not Affect Liver Regeneration After Portal Vein Embolization in the Treatment of Colorectal Liver Metastases 总被引:1,自引:1,他引:0
Background Blockage of vascular endothelial growth factor (VEGF) in murine models has been shown to impair liver regeneration after partial
hepatectomy. The aim of this study was to evaluate the effects of chemotherapy with or without bevacizumab (monoclonal antibody
anti-VEGF) on liver regeneration after portal vein embolization (PVE) in the treatment of colorectal liver metastases and
its possible effect on postoperative outcome after major liver resection.
Methods Records of 65 consecutive patients treated with or without preoperative chemotherapy (with or without bevacizumab) and PVE
for colorectal liver metastases from September 1995 to February 2007 were reviewed from a prospective database. Future liver
remnant (FLR) volume, degree of FLR hypertrophy after PVE, morbidity, mortality, and survival were analyzed.
Results Preoperative PVE was performed after chemotherapy in 43 patients and without chemotherapy in 22 patients. Among the 43 patients
treated with chemotherapy, 26 received concurrent bevacizumab. After a median of 4 weeks after PVE, there was no difference
in FLR volume increase among patients treated with or without chemotherapy. Similarly, there was no statistically significant
difference in degree of FLR hypertrophy among patients treated without (mean, 10.1%) or with chemotherapy, with or without
bevacizumab (8.8% and 6.8%) (P = .11). Forty-eight (74%) of 65 patients underwent extended right or right hepatectomy after PVE. No differences in morbidity
and mortality were observed among patients treated with or without preoperative chemotherapy (with or without bevacizumab).
Conclusion Preoperative chemotherapy with bevacizumab does not impair liver regeneration after PVE. Liver resection can be performed
safely in patients treated with bevacizumab before PVE.
Presented at The Society of Surgical Oncology, 61st Annual Cancer Symposium, Chicago, IL, March 13–16, 2008. 相似文献
10.
Background Portal vein embolization (PVE) improves outcome following major hepatectomy, and basic studies have presented evidence related
to the mechanisms responsible for hepatic regeneration. Hemodynamic changes following PVE are similar to, but slightly different
from, those of partial hepatectomy (PH) because arterial flow to the embolized lobe is preserved. However, the process of
hepatic regeneration is essentially the same after both PVE and PH. A number of mediators are involved in PVE or PH-induced
hepatic regeneration. These include inflammatory cytokines, vasoregulators, growth factors, eicosanoids, and various hormones.
These mediators activate a complex network of signal transduction that promotes hepatic regeneration. A variety of conditions
have been shown to modulate the function of these mediators and inhibit regeneration. These include biliary obstruction, diabetes,
chronic ethanol consumption, malnutrition, gender, aging, and infection.
Conclusion Optimizing these factors, where possible, before PVE or PH, is essential to maximize hypertrophy of the liver. A fuller understanding
of hepatic physiology and pathophysiology following PVE or PH may lead to greater functional capacity of the remaining liver
and extend the indications for hepatectomy in patients who require large liver volume resection. 相似文献
11.
Seo DD Lee HC Jang MK Min HJ Kim KM Lim YS Chung YH Lee YS Suh DJ Ko GY Lee YJ Lee SG 《Annals of surgical oncology》2007,14(12):3501-3509
BACKGROUND: Preoperative portal vein embolization (PVE) increases the future liver remnant (FLR) volume, thus enabling surgical resection in patients with small FLR volume. It is unclear, however, if this approach can enhance survival in patients with hepatocellular carcinoma (HCC). We therefore compared the outcomes of preoperative PVE and surgical resection with transarterial chemoembolization (TACE). METHODS: Changes in FLR volumes were analyzed in 32 HCC patients who underwent preoperative PVE and surgical resection. Long-term outcomes were compared with 64 TACE-treated patients matched for gender, Child-Turcotte-Pugh class, tumor size and number, serum alpha-fetoprotein levels, and UICC stage. RESULTS: In the PVE group, the baseline ratio of FLR/total estimated liver volumes (TELV) was 27.6 +/- 7.2%. Following PVE, FLR volume increased 34% (336.5 vs 449.4 mL, P < .001) and the ratio of FLR/TELV increased from 27.6 +/- 7.2 to 36.9 +/- 8.1% (P < .001). There was no mortality associated with PVE or surgical resection. The 5-year survival rate was significantly higher in the PVE group than in the TACE group (71.9% vs 45.6%, P = .03). Multivariate analysis showed that treatment modality was an independent predictive factor for survival (odds ratio 2.05, 95% confidence interval 1.01-4.16, P = .046). CONCLUSIONS: Preoperative PVE enables surgical resection in HCC patients with small FLR volume and improves patient survival compared with TACE. 相似文献
12.
Kuniya Tanaka Takafumi Kumamoto Ryusei Matsuyama Kazuhisa Takeda Yasuhiko Nagano Itaru Endo 《Journal of gastrointestinal surgery》2010,14(2):359-368
Background
Although portal vein embolization (PVE) and staged hepatectomy (StHx), as well as prehepatectomy chemotherapy, have improved the resectability rate of patients with multiple bilobar colorectal liver metastases, the impact of prehepatectomy chemotherapy on liver hypertrophy following PVE and/or StHx has remained unclear. 相似文献13.
Purpose
To evaluate the safety and efficacy of sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) prior to surgery in hepatocellular carcinoma (HCC) patients and to compare the clinical outcome of the combined procedure with that of a matched group of patients undergoing PVE alone.Patients and Methods
From 1997 to 2008, 135 patients with HCC underwent sequential TACE and PVE (n = 71) or PVE alone (n = 64) before right hepatectomy. PVE was performed mean 1.2 months after TACE. In both groups, computed tomography (CT) and liver volumetry were performed before and 2 weeks after PVE to assess degree of left lobe hypertrophy.Results
Baseline patient and tumor characteristics were similar in the two groups. After PVE, the chronological changes of liver enzymes were similar in the two groups. The mean increase in percentage future liver remnant (FLR) volume was higher in the TACE + PVE group (7.3%) than in the PVE-only group (5.8%) (P = 0.035). After surgery, incidence of hepatic failure was higher in the PVE-only group (12%) than in the TACE + PVE (4%) group (P = 0.185). Overall (P = 0.028) and recurrence-free (P = 0.001) survival rates were significantly higher in the TACE + PVE group than in the PVE-only group.Conclusion
Sequential TACE and PVE before surgery is a safe and effective method to increase the rate of hypertrophy of the FLR and leads to longer overall and recurrence-free survival in patients with HCC. 相似文献14.
Wu JS Kubo S Tanaka H Shuto T Takemura S Tsukamoto T Hirohashi K Kinoshita H 《Surgery today》2005,35(1):41-46
Purpose We investigated the correlation between serum concentrations of type IV collagen 7s domain (7s collagen) and changes in the volume of the nonembolized liver lobe after subsequent portal vein embolization (PVE).Methods The relationship between the pre-embolization results of laboratory tests and the increase in the left lobe volume was evaluated in 32 patients who underwent preoperative PVE via the right portal vein.Results By 2 weeks after PVE, the mean volume of the left lobe had increased significantly (P < 0.001). The percent increase in the left lobe volume correlated negatively with the pre-embolization serum concentration of 7s collagen (r = –0.472, P = 0.0063). In three of four patients with high serum concentrations (>8ng/ml), the percent increase was less than 100% and right lobectomy was not performed. The serum 7s collagen concentration correlated with the histologic activity score (r = 0.469, P = 0.0061) and the histologic fibrosis score (r = 0.425, P = 0.0145).Conclusion The serum concentration of 7s collagen may predict the efficacy of PVE. Performing PVE before right lobectomy may not be indicated in patients with high serum concentrations of 7s collagen because the increases in left lobe volume may be insufficient. 相似文献
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17.
Junichi Shindoh Ching-Wei D. Tzeng Thomas A. Aloia Steven A. Curley Steven Y. Huang Armeen Mahvash Sanjay Gupta Michael J. Wallace Jean-Nicolas Vauthey 《Journal of gastrointestinal surgery》2014,18(1):45-51
Introduction
Portal vein embolization (PVE) stimulates hypertrophy of the future liver remnant (FLR) and may improve the safety of extended hepatectomy. The efficacy of PVE was evaluated.Methods
Records of 358 consecutive patients who underwent PVE before intended major hepatectomy at our institution from 1995 through 2012 were retrospectively reviewed.Results
One hundred twelve patients (31.3 %) had right PVE alone; 235 (65.6 %) had right PVE plus segment IV embolization. The first-session PVE completion rate was 97.8 %. The PVE complication rate was 3.9 %. The median pre-PVE and post-PVE standardized FLRs were 19.5 % (interquartile range, 15.0–25.9) and 29.7 % (interquartile range, 22.5–38.2), respectively. Two hundred forty patients (67.0 %) underwent potentially curative resection. Sixty-two patients (25.8 %) had major post-hepatectomy complications; rates of postoperative hepatic insufficiency and 90-day liver-related mortality were 8.3 and 3.8 %, respectively. The proportion of patients with colorectal liver metastasis increased from 38.6 % before 2005 to 78.2 % in 2010–2012. Despite increased use of preoperative chemotherapy, postoperative hepatic insufficiency and 90-day liver-related mortality rates dropped from 10.6 and 4.1 %, respectively, before 2010 to 2.9 and 2.9 %, respectively, in 2010–2012.Conclusions
PVE can be safely performed with minimal morbidity. Most patients can proceed to extended hepatectomy, which is associated with a minimal mortality rate. 相似文献18.
Taku Aoki Hiroshi Imamura Yutaka Matsuyama Yoji Kishi Takashi Kobayashi Yasuhiko Sugawara Masatoshi Makuuchi Norihiro Kokudo 《Journal of gastrointestinal surgery》2011,15(9):1594-1601
Background
We investigated the long-term profiles of liver regeneration after living-donor hepatectomy. 相似文献19.
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 《Journal of gastrointestinal surgery》2016,20(7):1317-1323
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.20.
Morioka D Tanaka K Sekido H Matsuo K Sugita M Ueda M Endo I Togo S Shimada H 《Annals of surgical oncology》2006,13(12):1560-1568
Background To clarify the role of the middle hepatic vein (MHV) in liver regeneration of the remnant liver after right hemihepatectomy for hepatic tumors, we reviewed 29 patients to evaluate liver regeneration for up to 12 postoperative months.Methods Volume regeneration of the remnant liver was investigated by computed tomography at 3, 6, and 12 postoperative months. The remnant liver was divided into the following three areas: the medial section (segment IV), the lateral section (segments II and III), and segment I. The patients were divided into two groups: group A (n = 17), in which the MHV was preserved in the remnant liver, and group B (n = 12), in which the MHV was removed.Results Volume regeneration of each area continued until 6 postoperative months but did not increase thereafter. On univariate analysis, differences in the volume regeneration of each area between the groups were not significant at any measured time point. Furthermore, disruption of the MHV was determined to not be crucial to the volume regeneration of any liver area on multivariate analysis. Only the resection volume (percentage) significantly affected liver regeneration of the remnant liver.Conclusions Disruption of the MHV does not decisively affect liver regeneration of remnant liver after right hemihepatectomy for hepatic tumors. 相似文献