Boris Guiu1,2,3, François Quenet4, Laure Escal5, Frédéric Bibeau6, Lauranne Piron5, Philippe Rouanet4, Jean-Michel Fabre7, Eric Jacquet8, Alban Denys9, Pierre-Olivier Kotzki10,11, Daniel Verzilli12, Emmanuel Deshayes10,11. 1. Department of Radiology, St-Eloi University Hospital, 34980, Montpellier, France. B-guiu@chu-montpellier.fr. 2. INSERM U1194, Montpellier Cancer Research Institute, 34298, Montpellier, France. B-guiu@chu-montpellier.fr. 3. Department of Radiology, St-Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France. B-guiu@chu-montpellier.fr. 4. Department of Surgery, Institut du Cancer de Montpellier (ICM), 34298, Montpellier, France. 5. Department of Radiology, St-Eloi University Hospital, 34980, Montpellier, France. 6. Department of Pathology, Institut du Cancer de Montpellier (ICM), 34298, Montpellier, France. 7. Department of Surgery, St-Eloi University Hospital, 34295, Montpellier, France. 8. Department of Surgery, Beausoleil Clinic, 34980, Montpellier, France. 9. Department of Radiology, CHUV, Lausanne, Switzerland. 10. INSERM U1194, Montpellier Cancer Research Institute, 34298, Montpellier, France. 11. Department of Nuclear Medicine, Institut du Cancer de Montpellier (ICM), 34298, Montpellier, France. 12. Department of Anesthesiology, St-Eloi University Hospital, 34980, Montpellier, France.
Abstract
OBJECTIVE: The aim of this study was to assess the safety and efficacy of extended liver venous deprivation (eLVD), i.e. combination of right portal vein embolisation and right (accessory right) and middle hepatic vein embolisation before major hepatectomy for future remnant liver (FRL) functional increase. METHODS: eLVD was performed in non-cirrhotic patients referred for major hepatectomy in a context of small FRL (baseline FRL <25% of the total liver volume or FRL function <2.69%/min/m2). All patients underwent 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) and computed tomographic evaluations. RESULTS: Ten consecutive patients underwent eLVD before surgery for liver metastases (n = 8), Klatskin tumour (n = 1) and gallbladder carcinoma (n = 1). FRL function increased by 64.3% (range = 28.1-107.5%) at day 21. In patients with serial measurements, maximum FRL function was at day 7 (+65.7 ± 16%). The FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day). Thirty-one days (range = 22-45 days) after eLVD, 9/10 patients were resected. No post-hepatectomy liver failure was reported. Two grade II and one grade III complications (Dindo-Clavien classification) occurred. No patient died with-in 90 days following surgery. CONCLUSIONS: eLVD is safe and provides a marked and very rapid increase in liver function, unprecedented for an interventional radiology procedure. KEY POINTS: • eLVD is safe • eLVD provides a marked and very rapid increase in liver function • After eLVD, the FRL-F increased by 64.3% (28.1-107.5%) at day 21 • After eLVD, the maximum FRL-F was obtained at day 7 (+65.7 ± 16%) • After eLVD, the FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day).
OBJECTIVE: The aim of this study was to assess the safety and efficacy of extended liver venous deprivation (eLVD), i.e. combination of right portal vein embolisation and right (accessory right) and middle hepatic vein embolisation before major hepatectomy for future remnant liver (FRL) functional increase. METHODS: eLVD was performed in non-cirrhotic patients referred for major hepatectomy in a context of small FRL (baseline FRL <25% of the total liver volume or FRL function <2.69%/min/m2). All patients underwent 99mTc-mebrofeninhepatobiliary scintigraphy (HBS) and computed tomographic evaluations. RESULTS: Ten consecutive patients underwent eLVD before surgery for liver metastases (n = 8), Klatskin tumour (n = 1) and gallbladder carcinoma (n = 1). FRL function increased by 64.3% (range = 28.1-107.5%) at day 21. In patients with serial measurements, maximum FRL function was at day 7 (+65.7 ± 16%). The FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day). Thirty-one days (range = 22-45 days) after eLVD, 9/10 patients were resected. No post-hepatectomy liver failure was reported. Two grade II and one grade III complications (Dindo-Clavien classification) occurred. No patient died with-in 90 days following surgery. CONCLUSIONS: eLVD is safe and provides a marked and very rapid increase in liver function, unprecedented for an interventional radiology procedure. KEY POINTS: • eLVD is safe • eLVD provides a marked and very rapid increase in liver function • After eLVD, the FRL-F increased by 64.3% (28.1-107.5%) at day 21 • After eLVD, the maximum FRL-F was obtained at day 7 (+65.7 ± 16%) • After eLVD, the FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day).
Entities:
Keywords:
Hepatic vein; Liver; Portal vein embolisation; Scintigraphy; Surgery
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