David C Madoff1, Bruno C Odisio2, Erik Schadde3,4,5, Ron C Gaba6, Roelof J Bennink7, Thomas M van Gulik8, Boris Guiu9. 1. Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA. david.madoff@yale.edu. 2. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Surgery, Rush University Medical Center, Chicago, IL, USA. 4. Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland. 5. Institute of Physiology, Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland. 6. Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, IL, USA. 7. Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 8. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 9. Department of Radiology, St-Eloi University Hospital-Montpellier, Montpellier, France.
Abstract
PURPOSE OF REVIEW: For three decades, portal vein embolization (PVE) has been the "gold-standard" strategy to hypertrophy the anticipated future liver remnant (FLR) in advance of major hepatectomy. During this time, CT volumetry was the most common method to preoperatively assess FLR quality and function and used to determine which patients are appropriate surgical candidates. This review provides the most up-to-date methods for preoperatively assessing the anticipated FLR and summarizes data from the currently available strategies used to induce FLR hypertrophy before surgery for hepatobiliary malignancy. RECENT FINDINGS: Functional and physiological imaging is increasingly replacing standard CT volumetry as the method of choice for preoperative FLR assessment. PVE, associating liver partition and portal vein ligation, radiation lobectomy, and liver venous deprivation are all currently available techniques to hypertrophy the FLR. Each strategy has pros and cons based on tumor type, extent of resection, presence or absence of underlying liver disease, age, performance status, complication rates, and other factors. Numerous strategies can lead to FLR hypertrophy and improve the safety of major hepatectomy. Which is best has yet to be determined.
PURPOSE OF REVIEW: For three decades, portal vein embolization (PVE) has been the "gold-standard" strategy to hypertrophy the anticipated future liver remnant (FLR) in advance of major hepatectomy. During this time, CT volumetry was the most common method to preoperatively assess FLR quality and function and used to determine which patients are appropriate surgical candidates. This review provides the most up-to-date methods for preoperatively assessing the anticipated FLR and summarizes data from the currently available strategies used to induce FLR hypertrophy before surgery for hepatobiliary malignancy. RECENT FINDINGS: Functional and physiological imaging is increasingly replacing standard CT volumetry as the method of choice for preoperative FLR assessment. PVE, associating liver partition and portal vein ligation, radiation lobectomy, and liver venous deprivation are all currently available techniques to hypertrophy the FLR. Each strategy has pros and cons based on tumor type, extent of resection, presence or absence of underlying liver disease, age, performance status, complication rates, and other factors. Numerous strategies can lead to FLR hypertrophy and improve the safety of major hepatectomy. Which is best has yet to be determined.
Authors: Boris Guiu; Emmanuel Deshayes; Fabrizio Panaro; Florian Sanglier; Caterina Cusumano; Astrid Herrerro; Olivia Sgarbura; Nicolas Molinari; François Quenet; Christophe Cassinotto Journal: Ann Transl Med Date: 2021-05
Authors: Philip C Müller; Michael Linecker; Elvan O Kirimker; Christian E Oberkofler; Pierre-Alain Clavien; Deniz Balci; Henrik Petrowsky Journal: Langenbecks Arch Surg Date: 2021-03-19 Impact factor: 3.445