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portal vein embolization before major hepatectomy

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World Journal of Gastroenterology 2005年第14期11卷 2051-2054页

作者： HaiLiu YongFu DepartmentofSurgicalOncology HainanProvincialPeople'sHospitalHaikou570311HainanProvinceChina

To discuss the rationale, techniques and the unsolved issues regarding preoperative portal vein embolization (PVE) before major hepatectomy. After a systematic search of Pubmed, we reviewed and retrieved literature related to PVE. Preoperative PVE is an approach that is gaining increasing acceptance in the preoperative treatment of selected patients prior to major hepatic resection. Induction of selective hypertrophy of the nondiseased portion of the liver with PVE in patients with either primary or secondary hepatobiliary, malignancy with small estimated future liver remnants (FLR) may result in fewer complications and shorter hospital stays following resection. Additionally, PVE performed in patients initially considered unsuitable for resection due to lack of sufficient remaining normal parenchyma may add to the pool of candidates for surgical treatment. The results suggest that PVE is recomm-endable in treating the cirrhotic patients before major liver resection.

关键词： portal vein embolization Hepatectomy

portal vein embolization failure:Current strategies and future perspectives to improve liver hypertrophy before major oncological liver resection

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World Journal of Gastrointestinal Oncology 2022年第11期14卷 2088-2096页

作者： Gianluca Cassese Ho-Seong Han Boram Lee Jai Young Cho Hae Won Lee Boris Guiu Fabrizio Panaro Roberto Ivan Troisi Clinical Medicine and Surgery Federico II UniversityNaples 80131Italy Department of Surgery Seoul National University College of MedicineSeongnam 13620South Korea Department of Surgery Seoul National University Bundang HospitalSeongnam 13620South Korea Department of Medical Imaging and Interventional Radiology St-Eloi University HospitalMontpellier 34295France Digestive Surgery and Transplantation CHU de MontpellierMontpellier 34295France

portal vein embolization(PVE)is currently considered the standard of care to improve the volume of an inadequate future remnant liver(FRL)and decrease the risk of post-hepatectomy liver failure(PHLF).PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after *** degree of hypertrophy obtained after PVE is variable and depends on multiple *** to 20%of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure(usually 6-8 wk are needed before surgery).The management of PVE failure is still debated,with a lack of consensus regarding the best clinical *** additional techniques have been proposed,such as sequential transarterial chemoembolization followed by PVE,segment 4 PVE,intra-portal administration of stem cells,dietary supplementation,and hepatic vein *** aim of this review is to summarize the up-to-date strategies to overcome such difficult situations and discuss future perspectives on improving FRL hypertrophy.

关键词： portal vein embolization portal vein embolization failure Rescue associating liver partition and portal vein ligation Hepatic vein embolization Liver venous deprivation Segment 4 portal vein embolization

portal vein embolization for closure of marked arterioportal shunt of hepatocellular carcinoma to enable radioembolization:A case report

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2926-2931页

作者： Xiang-Dong Wang Nai-Jian Ge Ye-Fa Yang Department of Interventional Radiology Shanghai Eastern Hepatobiliary Surgery HospitalShanghai 200438China

BACKGROUND Marked arterioportal shunt(APS)can be a contraindication for transarterial radioembolization(TARE)because of the risk of radiation-induced liver toxicity or *** date,the best method to close marked APS to reduce intrahepatic shunt(IHS)and hepatopulmonary shunt(HPS)before TARE has not been *** SUMMARY This case report describes a novel strategy of embolization of the portal venous outlet to reduce IHS and HPS caused by marked APS before TARE in a patient with advanced hepatocellular carcinoma(HCC).The patient had a significant intratumoral shunt from the tumor artery to the portal vein and had already been suspected based on pre-interventional magnetic resonance angiography,and digital subtraction angiography(DSA)confirmed the *** right portal vein embolization(PVE)was performed to close the APS outlet and DSA confirmed complete ***-99m macroaggregated albumin was administered and single photon emission computed tomography revealed a low HPS with 8.4%.Successful TARE was subsequently *** major procedurerelated complication *** Closure of APS with PVE during mapping angiography of advanced-stage HCC to enable reduction of HPS and subsequent TARE is feasible.

关键词： portal vein embolization Arterioportal shunt Intrahepatic shunt Hepatopulmonary shunt Transarterial radioembolization Case report

portal vein embolization in the treatment of portal vein bleeding after percutaneous transhepatic biliary drainage: A case report and literature review

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Journal of Interventional Medicine 2022年第4期5卷 217-220页

作者： Hai Li Naijian Ge Chengjian He Xiangdong Wang Wei Xu Jian Huang Yefa Yang Mini-Invasive Intervention Center Third Affiliated Hospital of Naval Medical University/Shanghai Eastern Hepatobiliary Surgery HospitalShanghai200438China

Percutaneous transhepatic biliary drainage(PTBD)is an effective treatment for benign and malignant obstructive *** bleeding complications occur in approximately 2–3%of patients after PTBD,which can result in death.A case involving a 63-year-old male with malignant obstructive jaundice,who experienced severe bleeding after PTBD,is *** digital subtraction angiography,celiac trunk artery and superior mesenteric artery angiography were performed;however,no signs of arterial bleeding were *** identify etiology,portal venography was performed under ultrasound guidance and portal vein bleeding was ***,selective portal vein embolization successfully stopped the bleeding.

关键词： Percutaneous transhepatic biliary drainage portal vein embolization portal vein bleeding

Sequential transcatheter arterial chemoembolization and portal vein embolization before right hemihepatectomy in patients with hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2020年第3期19卷 244-251页

作者： Gil Chun Park Sung Gyu Lee Young In Yoon Kyu Bo Sung Gi Young Ko Dong Il Gwon Dong Hwan Jung Yong Kyu Jung Division of Hepatobiliary Surgery and Liver Transplantation Department of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea Department of Radiology and Research Institute of Radiology Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

Background:Recent studies showed that sequential selective transcatheter arterial chemoembolization(TACE)and portal vein embolization(PVE)provided better future liver remnant(FLR)regeneration rate and disease-free survival following surgery compared with PVE *** present study aimed to clarify whether preoperative sequential TACE and PVE before right hemihepatectomy can reduce postoperative hepatocellular carcinoma(HCC)recurrence and improve long-term disease-free and overall ***:Recurrence and survival outcomes were retrospectively evaluated in 205 patients with HCC who underwent right hemihepatectomy by a single surgeon from November 1993 to November *** were divided into four groups according to the procedure performed before the surgery:sequential TACE and PVE(TACE-PVE),PVE-only,TACE-only,or na?ve control *** baseline patient and tumor characteristics,postoperative outcomes,recurrence-free survival and overall survival were ***:Baseline patient and tumor characteristics upon diagnosis were similar in all four groups,while sequential TACE and PVE were well *** TACE-PVE group had a higher mean increase in percentage FLR volume compared with that of the PVE-only group(17.46%±6.63%vs.12.14%±5.93%;P=0.001).The TACE-PVE group had significantly better overall and disease-free survival rates compared with the other groups(both P<0.001).Conclusions:Sequential TACE and PVE prior to surgery can be an effective therapeutic strategy for patients with HCC scheduled for major hepatic *** active application of preoperative sequential TACE and PVE for HCC would allow more patients with marginal FLR volume to become candidates for major hepatic resection by promoting compensatory FLR hypertrophy without the deterioration of basal hepatic functional reserve or tumor progression.

关键词： Sequential selective transcatheter Arterial chemoembolization portal vein embolization Hepatocellular carcinoma Future liver remnant

Simultaneous transcatheter arterial chemoembolization and portal vein embolization for patients with large hepatocellular carcinoma before major hepatectomy

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World Journal of Gastroenterology 2020年第30期26卷 4489-4500页

作者： Cheng-Wu Zhang Chang-Wei Dou Xin-Long Zhang Xi-Qiang Liu Dong-Shen Huang Zhi-Ming Hu Jie Liu Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery Zhejiang Provincial People’s HospitalPeople’s Hospital of Hangzhou Medical CollegeHangzhou 310014Zhejiang ProvinceChina Department of General Surgery Aksu Area First HospitalAksu 843000Xinjiang Uygur Autonomous RegionChina

BACKGROUND Sequential transarterial chemoembolization(TACE)and portal vein embolization(PVE)are associated with long time interval that can allow tumor growth and nullify treatments'*** To evaluate the effect of simultaneous TACE and PVE for patients with large hepatocellular carcinoma(HCC)prior to elective major *** Fifty-one patients with large HCC who underwent PVE combined with or without TACE prior to hepatectomy were included in this study,with 13 patients in the simultaneous TACE+PVE group,17 patients in the sequential TACE+PVE group,and 21 patients in the PVE-only *** outcomes of the procedures were compared and *** All patients underwent *** mean interval from embolization to surgery,the kinetic growth rate of the future liver remnant(FLR),the degree of tumor size reduction,and complete tumor necrosis were significantly better in the simultaneous TACE+PVE group than in the other *** the patients in the simultaneous TACE+PVE group had a higher transaminase levels after PVE and TACE,they recovered to comparable levels with the other two groups before *** intraoperative course and the complication and mortality rates were similar among the three *** overall survival and disease-free survival were higher in the simultaneous TACE+PVE group than in the other two *** Simultaneous TACE and PVE is a safe and effective approach to increase FLR volume for patients with large HCC before major hepatectomy.

关键词： Transcatheter arterial chemoembolization portal vein embolization Major hepatectomy Hepatocellular carcinoma Future liver remnant

No difference in mortality among ALPPS,two-staged hepatectomy,and portal vein embolization/ligation:A systematic review by updated traditional and network meta-analyses

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Hepatobiliary & Pancreatic Diseases International 2020年第5期19卷 411-419页

作者： Paschalis Gavriilidis Robert P Sutcliffe Keith J Roberts Madhava Pai Duncan Spalding Nagy Habib Long R Jiao Mikael H Sodergren Department of Hepatopanceaticobiliary Surgery Imperial College Healthcare NHS TrustHammersmith HospitalLondon W120HSUK Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery Queen Elizabeth University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUK

Background:There is an ongoing debate on the feasibility,safety,and oncological efficacy of the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)*** aim of this study was to compare ALPPS,two-staged hepatectomy(TSH),and portal vein embolization(PVE)/ligation(PVL)using updated traditional meta-analysis and network meta-analysis(NMA).Data sources:Electronic databases were used in a systematic literature *** traditional metaanalysis and NMA were performed and *** and major morbidity were selected as primary ***:Nineteen studies including 1200 patients were selected from the pool of 436 *** these patients,315(31%)and 702(69%)underwent ALPPS and portal vein occlusion(PVO),*** mortality based on updated traditional meta-analysis,subgroup analysis of the randomized controlled trials(RCTs),and both Bayesian and frequentist NMA did not demonstrate significant differences between the ALPPS cohort and the PVE,PVL,and TSH ***,analysis of RCTs did not demonstrate significant differences of major morbidity between the ALPPS and PVO *** ALPPS cohort demonstrated significantly more favorable outcomes in hypertrophy parameters,time to operation,definitive hepatectomy,and R0 margins rates compared with the PVO *** contrast,1-year disease-free survival was significantly higher in the PVO cohort compared to the ALPPS ***:This study is the first to use updated traditional meta-analysis and both Bayesian and frequentist NMA and demonstrated no significant differences in 90-day mortality between the ALPPS and other hepatic hypertrophy ***,two high quality RCTs including 147 patients demonstrated no significant differences in major morbidity between the ALPPS and PVO cohorts.

关键词： ALPPS Hepatectomy portal vein embolization portal vein ligation Network meta-analysis

Non-target lung embolization during portal vein embolization due to an unrecognized portosystemic venous fistula:A case report

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World Journal of Clinical Cases 2023年第15期11卷 3625-3630页

作者： Sultan R Alharbi Mohammed Bin Nasif Haifa Bandar Alwaily Interventional Radiology Unit Department of RadiologyCollege of MedicineKing Saud UniversityKing Khalid University HospitalRiyadh 11362Saudi Arabia Department of Radiology College of MedicineKing Saud UniversityRiyadh 11362Saudi Arabia

BACKGROUND portal vein embolization(PVE)is an effective and relatively safe procedure performed prior to major hepatic resection to enhance future liver *** embolization during PVE is rare,and if it occurs,it usually affects the future liver *** portosystemic venous fistulas are extremely rare in non-cirrhotic *** report a case of non-targeted lung embolization during PVE due to an unrecognized intrahepatic portosystemic *** SUMMARY A 60-year-old male presented with metastatic colon cancer of the *** patient underwent preoperative right *** the embolization procedure,a small amount of glue and lipiodol emulsion was embolized to the heart and lungs through an unrecognized intrahepatic portosystemic *** patient remained clinically stable and underwent the planned hepatic resection after 4 wk,with an uneventful postoperative *** Conventional portograms and careful evaluation prior to PVE are advisable to avoid such complications.

关键词： portal vein embolization Non-target embolization Portosystemic venous fistula Case report

Gd-EOB-DTPA based magnetic resonance imaging for predicting liver response to portal vein embolization

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World Journal of Radiology 2017年第4期9卷 199-205页

作者： Janio Szklaruk Gustavo Luersen Jingfei Ma Wei Wei Michelle Underwood Department of Diagnostic Radiology the University of Texas MD Anderson Cancer CenterHoustonTX 77030United States Hospital Moinhos de Vento Rua Goncalo de CarvalhoPorto AlegreRS 90035-170Brazil

AIM To evaluate the correlation between degree of kinetic growth(k GR) of the liver following portal vein embolization(PVE) liver and the enhancement of the during the hepatobiliary phase of contrast administration and to evaluate if the enhancement can be used to predict response to PVE prior to the *** Seventeen patients were consented for the prospective *** patients had an MR of the abdomen with *** patients underwent *** correlation between the kG R of the liver and the degree of enhancement was evaluated with linear regression(strong assumptions) and Spearman's correlation test(rank based,no assumptions).The correlation was examined for the whole liver,segments I,VIII,VII,VI,V,IV,right liver and left *** There was no correlation between the degree of enhancement during the hepatobiliary phase and kG R for any segment,lobe of the liver or whole liver(P = 0.19 to 0.91 by Spearman's correlation test).CONCLUSION The relative enhancement of the liver during the hepatobiliary phase with Gd-EOB-DTPA cannot be used to predict the liver response to PVE.

关键词： Gd-EOB-DTPA Liver magnetic resonance imaging portal vein embolization Resection Kinetic growth