Shin Hwang1, Tae-Yong Ha2, Gi-Young Ko3, Dong-Il Kwon3, Gi-Won Song2, Dong-Hwan Jung2, Myung-Hwan Kim4, Sung-Koo Lee4, Sung-Gyu Lee2. 1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. shwang@amc.seoul.kr. 2. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 3. Department of Diagnostic Imaging, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 4. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Abstract
BACKGROUND: Preoperative portal vein embolization (PVE) induces shrinkage of the embolized lobe and compensatory regeneration in the non-embolized lobe, but does not always induce sufficient regeneration of the future remnant liver (FRL). We previously developed preoperative sequential PVE-hepatic vein embolization (HVE), and here we present our experience of treating 42 patients with sequential PVE-HVE. METHODS: During 8-year study period, preoperative PVE-HVE was performed on 42 patients with hepatobiliary malignancies. RESULTS: Primary diseases were bile duct cancers [perihilar cholangiocarcinoma (n = 33) and diffuse bile duct cancer (n = 1)], hepatocellular carcinomas (n = 4), and intrahepatic tumors [intrahepatic cholangiocarcinoma (n = 3) and gallbladder cancer liver invasion (n = 1)]. These patients demonstrated insufficient FRL regeneration following PVE, thus HVE was performed to induce further regeneration. No PVE-HVE procedure-associated complications occurred. In the bile duct cancer group, FRL volume was 33.9 ± 2.2 % before PVE, 38.4 ± 1.5 % before HVE, 43.7 ± 2.1 % at surgery, and 73.6 ± 8.3 % at 2 weeks after right hepatectomy. The degree of FRL hypertrophy was 13.3 % after PVE, 28.9 % after PHV-HVE, and 117.1 % at 2 weeks after right hepatectomy. All patients except one recovered uneventfully after surgery, and the 3-year patient survival rate was 45.1 %. In the HCC group, transarterial chemoembolization was initially performed and FRL regeneration following PVE-HVE occurred very slowly. Active FRL regeneration occurred in the liver tumor group, but rapid tumor growth was observed in 1 of 4 patients. CONCLUSION: The sequential application of HVE following PVE safely and effectively induces further FRL regeneration in non-cirrhotic livers. Further validation using larger patient population and multicenter studies is needed to reliably widen the indications.
BACKGROUND: Preoperative portal vein embolization (PVE) induces shrinkage of the embolized lobe and compensatory regeneration in the non-embolized lobe, but does not always induce sufficient regeneration of the future remnant liver (FRL). We previously developed preoperative sequential PVE-hepatic vein embolization (HVE), and here we present our experience of treating 42 patients with sequential PVE-HVE. METHODS: During 8-year study period, preoperative PVE-HVE was performed on 42 patients with hepatobiliary malignancies. RESULTS:Primary diseases were bile duct cancers [perihilar cholangiocarcinoma (n = 33) and diffuse bile duct cancer (n = 1)], hepatocellular carcinomas (n = 4), and intrahepatic tumors [intrahepatic cholangiocarcinoma (n = 3) and gallbladder cancer liver invasion (n = 1)]. These patients demonstrated insufficient FRL regeneration following PVE, thus HVE was performed to induce further regeneration. No PVE-HVE procedure-associated complications occurred. In the bile duct cancer group, FRL volume was 33.9 ± 2.2 % before PVE, 38.4 ± 1.5 % before HVE, 43.7 ± 2.1 % at surgery, and 73.6 ± 8.3 % at 2 weeks after right hepatectomy. The degree of FRL hypertrophy was 13.3 % after PVE, 28.9 % after PHV-HVE, and 117.1 % at 2 weeks after right hepatectomy. All patients except one recovered uneventfully after surgery, and the 3-year patient survival rate was 45.1 %. In the HCC group, transarterial chemoembolization was initially performed and FRL regeneration following PVE-HVE occurred very slowly. Active FRL regeneration occurred in the liver tumor group, but rapid tumor growth was observed in 1 of 4 patients. CONCLUSION: The sequential application of HVE following PVE safely and effectively induces further FRL regeneration in non-cirrhotic livers. Further validation using larger patient population and multicenter studies is needed to reliably widen the indications.
Authors: S Hayashi; Y Baba; K Ueno; M Nakajo; F Kubo; S Ueno; T Aikou; T Komokata; N Nakamura; R Sakata Journal: Acta Radiol Date: 2007-09 Impact factor: 1.990
Authors: Sung Gyu Lee; Gi Won Song; Shin Hwang; Tae Yong Ha; Deok Bog Moon; Dong Hwan Jung; Ki Hun Kim; Chul Soo Ahn; Myung Hwan Kim; Sung Koo Lee; Kyu Bo Sung; Gi Young Ko Journal: J Hepatobiliary Pancreat Sci Date: 2009-10-23 Impact factor: 7.027
Authors: Roland Brüning; Martin Schneider; Michel Tiede; Peter Wohlmuth; Gregor Stavrou; Thomas von Hahn; Andrea Ehrenfeld; Tim Reese; Georgios Makridis; Axel Stang; Karl J Oldhafer Journal: CVIR Endovasc Date: 2021-05-17