S M P Balzan1, V G Gava2, M A Magalhaes3, M L Dotto4. 1. Department of Surgery, Moinhos de Vento Hospital, Porto Alegre, Brazil; University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil; Oncological Center of Ana Nery Hospital and Saint Gallen Institute of Oncology, Santa Cruz do Sul, Brazil. Electronic address: sbalzan@hotmail.com. 2. Department of Surgery, Moinhos de Vento Hospital, Porto Alegre, Brazil; University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil. 3. Oncological Center of Ana Nery Hospital and Saint Gallen Institute of Oncology, Santa Cruz do Sul, Brazil. 4. University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil; Oncological Center of Ana Nery Hospital and Saint Gallen Institute of Oncology, Santa Cruz do Sul, Brazil.
Abstract
BACKGROUND: Stimulation of hepatic hypertrophy is a useful aid to accomplish hepatic resections when the future liver remnant (FLR) is small. Although inflow occlusion, especially through portal flow, has been extensively studied, the role of outflow modulation has not yet been described. METHODS: Description of outflow modulation to tailor hypertrophy of future liver remnant in the context of bilobar metastatic disease. A patient with small FLR (segments I and IV) was managed with a two-stage procedure. The first stage consisted of a right hepatectomy and modulation of the left hepatic vein outflow through reduction of its diameter, with macroscopic congestion of segments II-III. The second stage consisted of a left lateral sectionectomy six weeks later. Postoperative courses were uneventful without any sign of liver failure. RESULTS: Following the first stage procedure computed tomography revealed distinct hypertrophy rates between sections. The non-congested area had an increase of 156% in the volume of segment IV (from 137 to 351 cm(3)) and 100% in the volume of segment I (from 20 to 40 cm(3)). The congested area, segments II-III, increased only 24% (from 205 to 253 cm(3)). CONCLUSION: Modulation of liver outflow allows maintenance of function in the segments to be resected while avoiding their hypertrophy. This process prevents liver failure and optimizes regeneration of hepatic territories to be preserved.
BACKGROUND: Stimulation of hepatic hypertrophy is a useful aid to accomplish hepatic resections when the future liver remnant (FLR) is small. Although inflow occlusion, especially through portal flow, has been extensively studied, the role of outflow modulation has not yet been described. METHODS: Description of outflow modulation to tailor hypertrophy of future liver remnant in the context of bilobar metastatic disease. A patient with small FLR (segments I and IV) was managed with a two-stage procedure. The first stage consisted of a right hepatectomy and modulation of the left hepatic vein outflow through reduction of its diameter, with macroscopic congestion of segments II-III. The second stage consisted of a left lateral sectionectomy six weeks later. Postoperative courses were uneventful without any sign of liver failure. RESULTS: Following the first stage procedure computed tomography revealed distinct hypertrophy rates between sections. The non-congested area had an increase of 156% in the volume of segment IV (from 137 to 351 cm(3)) and 100% in the volume of segment I (from 20 to 40 cm(3)). The congested area, segments II-III, increased only 24% (from 205 to 253 cm(3)). CONCLUSION: Modulation of liver outflow allows maintenance of function in the segments to be resected while avoiding their hypertrophy. This process prevents liver failure and optimizes regeneration of hepatic territories to be preserved.
Authors: Boris Guiu; Patrick Chevallier; Alban Denys; Elisabeth Delhom; Marie-Ange Pierredon-Foulongne; Philippe Rouanet; Jean-Michel Fabre; François Quenet; Astrid Herrero; Fabrizio Panaro; Guillaume Baudin; Jeanne Ramos Journal: Eur Radiol Date: 2016-04-18 Impact factor: 5.315
Authors: Bertrand Le Roy; Antoine Perrey; Mikael Fontarensky; Johan Gagnière; Armand Abergel; Bruno Pereira; Celine Lambert; Louis Boyer; Denis Pezet; Pascal Chabrot; Emmanuel Buc Journal: World J Surg Date: 2017-07 Impact factor: 3.352