Boris Guiu1,2, Patrick Chevallier3, Alban Denys4, Elisabeth Delhom5, Marie-Ange Pierredon-Foulongne5, Philippe Rouanet6, Jean-Michel Fabre7, François Quenet6, Astrid Herrero7, Fabrizio Panaro7, Guillaume Baudin3, Jeanne Ramos8. 1. Department of Radiology, St-Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France. B-guiu@chu-montpellier.fr. 2. INSERM U896, Montpellier Cancer Research Institute, 34298, Montpellier, France. B-guiu@chu-montpellier.fr. 3. Department of Radiology, Archet University Hospital, 06000, Nice, France. 4. Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 5. Department of Radiology, St-Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France. 6. Department of Surgery, Institut du Cancer de Montpellier, 34298, Montpellier, France. 7. Department of Surgery, St-Eloi University Hospital, 34295, Montpellier, France. 8. Department of Histology, St-Eloi University Hospital, 34980, Montpellier, France.
Abstract
PURPOSE: To assess technical feasibility, safety, and efficacy of the liver venous deprivation (LVD) technique that combines both portal and hepatic vein embolization during the same procedure for liver preparation before major hepatectomy. MATERIALS AND METHODS: Seven patients (mean age:63.6y[42-77y]) underwent trans-hepatic LVD for liver metastases (n = 2), hepatocellular carcinoma (n = 1), intrahepatic cholangiocarcinoma (n = 3) and Klatskin tumour (n = 1). Assessment of future remnant liver (FRL) volume, liver enzymes and histology was performed. RESULTS: Technical success was 100 %. No complication occurred before surgery. Resection was performed in 6/7 patients. CT-scan revealed hepatic congestion in the venous-deprived area (6/7 patients). A mean of 3 days (range: 1-8 days) after LVD, transaminases increased (AST: from 42 ± 24U/L to 103 ± 118U/L, ALT: from 45 ± 25U/L to 163 ± 205U/L). Twenty-three days (range: 13-30 days) after LVD, FRL increased from 28.2 % (range: 22.4-33.3 %) to 40.9 % (range: 33.6-59.3 %). During the first 7 days, venous-deprived liver volume increased (+13.4 %) probably reflecting vascular congestion, whereas it strongly decreased (-21.3 %) at 3-4 weeks. Histology (embolized lobe) revealed sinusoidal dilatation, hepatocyte necrosis and important atrophy in all patients. CONCLUSION: Trans-hepatic LVD technique is feasible, well tolerated and provides fast and important hypertrophy of the FRL. This new technique needs to be further evaluated and compared to portal vein embolization. KEY POINTS: • Twenty-three days after LVD, FRL increased from 28.2 % (range:22.4-33.3 %) to 40.9 % (range:33.6-59.3 %) • During the first 7 days, venous-deprived liver volume increased (+13.4 %) • Venous-deprived liver volume strongly decreased (mean atrophy:229 cc; -21.3 %) at 3-4 weeks • Histology of venous-deprived liver revealed sinusoidal dilatation, hepatocyte necrosis and important atrophy.
PURPOSE: To assess technical feasibility, safety, and efficacy of the liver venous deprivation (LVD) technique that combines both portal and hepatic vein embolization during the same procedure for liver preparation before major hepatectomy. MATERIALS AND METHODS: Seven patients (mean age:63.6y[42-77y]) underwent trans-hepatic LVD for liver metastases (n = 2), hepatocellular carcinoma (n = 1), intrahepatic cholangiocarcinoma (n = 3) and Klatskin tumour (n = 1). Assessment of future remnant liver (FRL) volume, liver enzymes and histology was performed. RESULTS: Technical success was 100 %. No complication occurred before surgery. Resection was performed in 6/7 patients. CT-scan revealed hepatic congestion in the venous-deprived area (6/7 patients). A mean of 3 days (range: 1-8 days) after LVD, transaminases increased (AST: from 42 ± 24U/L to 103 ± 118U/L, ALT: from 45 ± 25U/L to 163 ± 205U/L). Twenty-three days (range: 13-30 days) after LVD, FRL increased from 28.2 % (range: 22.4-33.3 %) to 40.9 % (range: 33.6-59.3 %). During the first 7 days, venous-deprived liver volume increased (+13.4 %) probably reflecting vascular congestion, whereas it strongly decreased (-21.3 %) at 3-4 weeks. Histology (embolized lobe) revealed sinusoidal dilatation, hepatocyte necrosis and important atrophy in all patients. CONCLUSION: Trans-hepatic LVD technique is feasible, well tolerated and provides fast and important hypertrophy of the FRL. This new technique needs to be further evaluated and compared to portal vein embolization. KEY POINTS: • Twenty-three days after LVD, FRL increased from 28.2 % (range:22.4-33.3 %) to 40.9 % (range:33.6-59.3 %) • During the first 7 days, venous-deprived liver volume increased (+13.4 %) • Venous-deprived liver volume strongly decreased (mean atrophy:229 cc; -21.3 %) at 3-4 weeks • Histology of venous-deprived liver revealed sinusoidal dilatation, hepatocyte necrosis and important atrophy.
Entities:
Keywords:
Hepatic Vein; Histology; Liver; Portal Vein Embolization; Surgery
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