Liver venous deprivation compared to portal vein embolization to induce hypertrophy of the future liver remnant before major hepatectomy: A single center experience.

Details

Serval ID
serval:BIB_5D82CF76A4F9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Liver venous deprivation compared to portal vein embolization to induce hypertrophy of the future liver remnant before major hepatectomy: A single center experience.
Journal
Surgery
Author(s)
Kobayashi K., Yamaguchi T., Denys A., Perron L., Halkic N., Demartines N., Melloul E.
ISSN
1532-7361 (Electronic)
ISSN-L
0039-6060
Publication state
Published
Issued date
06/2020
Peer-reviewed
Oui
Volume
167
Number
6
Pages
917-923
Language
english
Notes
Publication types: Comparative Study ; Journal Article
Publication Status: ppublish
Abstract
To assess the safety and efficacy of liver venous deprivation (simultaneous hepatic vein embolization with portal vein embolization) compared with portal vein embolization alone before major hepatectomy in patients with small future liver remnant.
We assessed all consecutive patients who underwent ipsilateral liver venous deprivation before major hepatectomy (>4 Couinaud's segments) at the University Hospital Lausanne from 2016 to 2018. Postembolization, volumetric analysis after liver venous deprivation and postoperative outcomes were compared with patients who underwent portal vein embolization alone (portal vein embolization group) from 2010 to 2016.
During the study period, 21 patients underwent liver venous deprivation and 39 portal vein embolization alone. In the liver venous deprivation versus portal vein embolization groups, dropout rate owing to disease progression was 1 of 21 vs 9 of 39 (P = .053). There were no per procedural complications after liver venous deprivation and no difference in the postoperative outcomes. Future liver remnant hypertrophy was greater in the liver venous deprivation group (median 135%, interquartile range: 123%-154%) than in the portal vein embolization group (median 124%, interquartile range: 107%-140%) at a median time of 22 days after liver venous deprivation vs 26 days after portal vein embolization (P = .034). The median kinetic growth rate was also greater (2.9%/week, interquartile range: 1.9-4.3% vs 1.4%/week, interquartile range: 0.7-2.1%; P < .001).
Ipsilateral liver venous deprivation before major hepatectomy is safe and seems to induce a greater and faster future liver remnant hypertrophy than after portal vein embolization alone. More data are needed to analyze the impact of liver venous deprivation on tumor growth.
Keywords
Adult, Aged, Aged, 80 and over, Embolization, Therapeutic, Female, Hepatectomy, Hepatic Veins, Humans, Hypertrophy, Liver/diagnostic imaging, Liver/pathology, Liver Function Tests, Liver Neoplasms/surgery, Liver Regeneration, Male, Middle Aged, Portal Vein, Preoperative Care, Tomography, X-Ray Computed
Pubmed
Web of science
Create date
06/02/2020 17:27
Last modification date
18/12/2020 6:26
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