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Simultaneous portal and hepatic vein embolization is better than portal embolization or ALPPS for hypertrophy of future liver remnant before major hepatectomy: A systematic review and network meta-analysis

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Hepatobiliary & Pancreatic Diseases International 2023年第3期22卷 221-227页

作者： Paschalis Gavriilidis Gabriele Marangoni Jawad Ahmad Daniel Azoulay Department of Hepatobiliary and Pancreatic Surgery University Hospitals of Coventry and Warwickshire NHS TrustClifford Bridge RoadCoventry CV22DXUK Department of Hepato-Biliary and liver Transplantation Surgery Paul Brousse University HospitalParis-Saclay UniversityVillejuif 94800France

Background:Post-hepatectomy liver failure(PHLF)is the Achilles’heel of hepatic resection for colorectal liver *** most commonly used procedure to generate hypertrophy of the functional liver remnant(FLR)is portal vein embolization(PVE),which does not always lead to successful *** liver partition and portal vein ligation for staged hepatectomy(ALPPS)has been proposed to overcome the limitations of *** venous deprivation(LVD),a technique that includes simultaneous portal and hepatic vein embolization,has also been proposed as an alternative to *** present study aimed to conduct a systematic review as the first network meta-analysis to compare the efficacy,effectiveness,and safety of the three regenerative *** sources:A systematic search for literature was conducted using the electronic databases Embase,PubMed(MEDLINE),Google Scholar and ***:The time to operation was significantly shorter in the ALPPS cohort than in the PVE and LVD cohorts by 27 and 22 days,*** parameters of blood loss and the Pringle maneuver demonstrated non-significant differences between the PVE and LVD *** was evidence of a significantly higher FLR hypertrophy rate in the ALPPS cohort when compared to the PVE cohort,but non-significant differences were observed when compared to the LVD ***,the LVD cohort demonstrated a significantly better FLR/body weight(BW)ratio compared to both the ALPPS and PVE *** the PVE and LVD cohorts demonstrated significantly lower major morbidity rates compared to the ALPPS *** LVD cohort also demonstrated a significantly lower 90-day mortality rate compared to both the PVE and ALPPS ***:LVD in adequately selected patients may induce adequate and profound FLR hypertrophy before major *** evidence demonstrated significantly lower major morbidity and mortality rates in the LVD cohort than in the ALPPS and PVE coho

关键词： Portal vein embolization Hepatic vein embolization future liver remnant ALPPS

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CD4^(+)CD25^(+) regulatory T cells decreased future liver remnant after associating liver partition and portal vein ligation for staged hepatectomy

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World Journal of Gastrointestinal Surgery 2023年第5期15卷 917-930页

作者： Wei Wang Chun-Hui Ye Zhen-Feng Deng Ji-Long Wang Ling Zhang Li Bao Bang-Hao Xu Hai Zhu Ya Guo Zhang Wen Department of Hepatobiliary Surgery The First Affiliated Hospital of Guangxi Medical UniversityNanning 530021Guangxi Zhuang Autonomous RegionChina Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer The First Affiliated Hospital of Guangxi Medical UniversityNanning 530021Guangxi Zhuang Autonomous RegionChina Department of Radiology The First Affiliated Hospital of Guangxi Medical UniversityNanning 530021Guangxi Zhuang Autonomous RegionChina Key Laboratory of Cancer Prevention and Therapy Tianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerTianjin 300000China

BACKGROUND Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is an innovative surgical approach for the treatment of massive hepatocellular carcinoma(HCC),the key to successful planned stage 2 ALPPS is future liver remnant(FLR)volume growth,but the exact mechanism has not been *** correlation between regulatory T cells(Tregs)and postoperative FLR regeneration has not been *** To investigate the effect of CD4^(+)CD25^(+)Tregs on FLR regeneration after *** Clinical data and specimens were collected from 37 patients who developed massive HCC treated with *** cytometry was performed to detect changes in the proportion of CD4^(+)CD25^(+)Tregs to CD4^(+)T cells in peripheral blood before and after *** analyze the relationship between peripheral blood CD4^(+)CD25^(+)Treg proportion and clinicopathological information and liver *** The postoperative CD4^(+)CD25^(+)Treg proportion in stage 1 ALPPS was negatively correlated with the amount of proliferation volume,proliferation rate,and kinetic growth rate(KGR)of the FLR after stage 1 *** with low Treg proportion had significantly higher KGR than those with high Treg proportion(P=0.006);patients with high Treg proportion had more severe postoperative pathological liver fibrosis than those with low Treg proportion(P=0.043).The area under the receiver operating characteristic curve between the percentage of Tregs and proliferation volume,proliferation rate,and KGR were all greater than *** CD4^(+)CD25^(+)Tregs in the peripheral blood of patients with massive HCC at stage 1 ALPPS were negatively correlated with indicators of FLR regeneration after stage 1 ALPPS and may influence the degree of fibrosis in patients’*** percentage was highly accurate in predicting the FLR regeneration after stage 1 ALPPS.

关键词： Associating liver partition and portal vein ligation for staged hepatectomy Regulatory T cells future liver remnant

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Minimizing the risk of small-for-size syndrome after liver surgery

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Hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 113-133页

作者： Michail Papamichail Michail Pizanias NigelD Heaton Department of Hepato-Pancreato-Biliary Surgery Royal Blackburn HospitalBlackburn BB23HHUK Department of General Surgery Whittington HospitalLondon N195NFUK Department of liver Transplant and Hepato-Pancreato-Biliary Surgery Institute of Liver StudiesKings Health Partners at King’s College Hospital NHS TrustLondon SE59RSUK

Background: Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant(FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-forsize syndrome(SFSS). Data sources: This comprehensive review analyzed the principles, mechanism and risk factors associated with SFSS and presented current available options in the evaluation of FLR when planning liver surgery. In addition, it provided a detailed description of specifc modalities that can be used before, during or after surgery, in order to optimize the conditions for a safe resection and minimize the risk of SFSS. Results: Several methods which aim to reduce tumor burden, preserve healthy liver parenchyma, induce hypertrophy of FLR or prevent postoperative complications help minimize the risk of SFSS. Conclusions: With those techniques the indications of radical treatment for patients with liver tumors have signifcantly expanded. The successful outcome depends on appropriate patient selection, the individualization and modifcation of interventions and the right timing of surgery.

关键词： Small-for-size syndrome liver resection future liver remnant

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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

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Portal vein embolization for induction of selective hepatic hypertrophy prior to major hepatectomy: rationale,techniques, outcomes and future directions

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Cancer Biology & Medicine 2016年第4期13卷 426-442页

作者： David Li David C.Madoff Department of Radiology Division of Interventional Radiology New York-Presbyterian Hospital Weill Cornell Medical Center

The ability to modulate the future liver remnant(FLR) is a key component of modern oncologic hepatobiliary surgery practice and has extended surgical candidacy for patients who may have been previously thought unable to survive liver resection. Multiple techniques have been developed to augment the FLR including portal vein embolization(PVE), associating liver partition and portal vein ligation(ALPPS), and the recently reported transhepatic liver venous deprivation(LVD). PVE is a well-established means to improve the safety of liver resection by redirecting blood flow to the FLR in an effort to selectively hypertrophy and ultimately improve functional reserve of the FLR. This article discusses the current practice of PVE with focus on summarizing the large number of published reports from which outcomes based practices have been developed. Both technical aspects of PVE including volumetry, approaches, and embolization agents; and clinical aspects of PVE including data supporting indications, and its role in conjunction with chemotherapy and transarterial embolization will be highlighted. PVE remains an important aspect of oncologic care; in large part due to the substantial foundation of information available demonstrating its clear clinical benefit for hepatic resection candidates with small anticipated FLRs.

关键词： Portal vein embolization future liver remnant hypertrophy liver regeneration liver cancer hepatocellular carcinoma liver metastases

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Novel liver vein deprivation technique that promotes increased residual liver volume(with video):A case report

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World Journal of Clinical Cases 2022年第31期10卷 11579-11584页

作者： Gang Wu Ji-Peng Jiang Dong-Hui Cheng Chong Yang Dong-Xu Liao Yu-Bo Liao Wan-Yee Lau Yu Zhang Department of Hepatobiliary Surgery Sichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengdu 610072Sichuan ProvinceChina Organ Transplantation Center Sichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengdu 610072Sichuan ProvinceChina Faculty of Medicine The Chinese University of Hong KongPrince of Wales HospitalHongkong 999077China

BACKGROUND Inadequate volume of future liver remnant(FLR)is a major challenge for hepatobiliary surgeons treating large or multiple liver *** an alternative to associating liver partition and portal vein ligation(ALPPS)for staged hepatectomy and liver venous deprivation(LVD)using stage 1 interventional radiology for vascular embolization combined with stage 2 open liver resection have been *** SUMMARY A novel modified LVD technique was performed in a patient with pancreatic neuroendocrine tumor with liver metastases by using stage 1 laparoscopic ligation of the right hepatic vein,right posterior portal vein,and short hepatic veins combined with local excision of three liver metastases in the left *** operation was followed three days later by interventional radiology to embolize an anomalous right anterior portal vein to complete LVD.A stage 2 laparoscopic right hemihepatectomy and pancreaticosplenectomy were then carried *** The minimally invasive technique promoted a rapid increase,comparable to ALPPS,in volume of the FLR after the stage 1 operation to allow the laparoscopic stage 2 resection to be performed.

关键词： Laparoscopic liver venous deprivation future liver remnant Case report

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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

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Neoadjuvant chemotherapy for colorectal liver metastases:A contemporary review of the literature

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World Journal of Gastrointestinal Oncology 2021年第9期13卷 1043-1061页

作者： Marissa Guo Ning Jin Timothy Pawlik Jordan M Cloyd Department of Surgery The Ohio State University Medical CenterColumbusOH 43210United States Department of Internal Medicine Division of Medical OncologyThe Ohio State University Medical CenterColumbusOH 43210United States Department of Surgery The Ohio State UniversityColumbusOH 43210United States Department of Surgery Division of Surgical OncologyThe Ohio State University Medical CenterColumbusOH 43210United States

Colorectal carcinoma(CRC)is one of the leading causes of cancer-related deaths worldwide,and up to 50%of patients with CRC develop colorectal liver metastases(CRLM).For these patients,surgical resection remains the only opportunity for cure and long-term *** the past few decades,outcomes of patients with metastatic CRC have improved significantly due to advances in systemic therapy,as well as improvements in operative technique and perioperative *** in the modern era of oxaliplatin-and irinotecancontaining regimens has been augmented by the introduction of targeted biologics and immunotherapeutic *** increasing efficacy of contemporary systemic therapies has led to an expansion in the proportion of patients eligible for curative-intent ***,the use of neoadjuvant strategies is becoming progressively more *** patients with CRLM,the primary advantage of neoadjuvant chemotherapy(NCT)is the potential to down-stage metastatic disease in order to facilitate hepatic *** the other hand,the routine use of NCT for patients with resectable metastases remains controversial,especially given the potential risk of inducing chemotherapy-associated liver injury prior to *** guidelines recommend upfront surgery in patients with initially resectable disease and low operative risk,reserving NCT for patients with borderline resectable or unresectable disease and high operative *** undergoing NCT require close monitoring for tumor response and conversion of CRLM to *** light of the growing number of treatment options available to patients with metastatic CRC,it is generally agreed that these patients are best served at tertiary centers with an expert multidisciplinary team.

关键词： Colorectal liver metastases Neoadjuvant chemotherapy Hepatic resection Conversion therapy Chemotherapy-associated liver injury Disappearing liver metastases future liver remnant Immunotherapy

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Preoperative portal vein embolization for hepatocellular carcinoma: consensus and controversy

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World Journal of Hepatology 2016年第9期8卷 439-445页

作者： Taku Aoki Keiichi Kubota Second Department of Surgery Dokkyo Medical University

Thirty years have passed since the first report of portal vein embolization(PVE),and this procedure is widely adopted as a preoperative treatment procedure for patients with a small future liver remnant(FLR).PVE has been shown to be useful in patients with hepatocellular carcinoma(HCC)and chronic liver ***,special caution is needed when PVE is applied prior to subsequent major hepatic resection in cases with cirrhotic livers,and volumetric analysis of the liver segments in addition to evaluation of the liver functional reserve before PVE is mandatory in such *** in the embolic material and selection of the treatment approach,and combined use of PVE and transcatheter arterial embolization/chemoembolization have yielded improved outcomes after PVE and major hepatic resections.A novel procedure termed the associating liver partition and portal vein ligation for staged hepatectomy has been gaining attention because of the rapid hypertrophy of the FLR observed in patients undergoing this procedure,however,application of this technique in HCC patients requires special caution,as it has been shown to be associated with a high morbidity and mortality even in cases with essentially healthy livers.

关键词： Hepatocellular carcinoma future liver remnant Poral vein embolization liver functional reserve The associating liver partition and portal vein ligation for staged hepatectomy

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Associating liver partition and portal vein ligation for staged hepatectomy for colorectal liver metastasis:a single-center experience

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iliver 2022年第1期1卷 25-29页

作者： Yuanfei Peng Feiyu Chen Zheng Wang Xiaoying Wang Yinghong Shi Zhenbing Ding Yongsheng Xiao Kang Song Lei Yu Jie Hu Min Tang Zhaoyou Tang Jia Fan Jian Zhou Department of liver Surgery and Transplantation Liver Cancer InstituteZhongshan HospitalFudan UniversityShanghaiChina Department of Radiology Zhongshan HospitalFudan UniversityShanghaiChina Institute of Biomedical Sciences Fudan UniversityShanghaiChina State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development School of Life SciencesFudan UniversityShanghaiChina Shanghai Key Laboratory of Organ Transplantation ShanghaiChina Key Laboratory of Carcinogenesis and Cancer Invasion Ministry of EducationFudan UniversityShanghaiChina

Background:Associated liver partition and portal vein ligation for staged hepatectomy(ALPPS)is increasingly used for the treatment of primarily unresectable colorectal liver metastases(CRLM)because of the insufficient future liver remnant(FLR).The aim of this study was to share our experience with ALPPS for advanced CRLM and review the role of ALPPS in the management of patients with ***:Consecutive patients(n=10)with CRLM who underwent ALPPS at our center between December 2014 and October 2021 were retrospectively ***:The median age of patients was 58 years(range 49–70 years).Five patients had metachronous CRLM and the other 5 patients had synchronous *** patients had unilateral CRLM and the other 5 patients had bilateral *** patients previously underwent neoadjuvant *** FLR volume increased by 45.3%(35.8%–61.6%)over 14 days(range 7–21 days).The absolute and relative kinetic growth rates were 17.9 mL/day(range 7.5–32.1 mL/day)and 4.6%/day(range 2.3%–8.8%/day),*** morbidity rates were 20%(2/10)and 40%(4/10)after ALPPS stage 1 and stage 2,*** 30-day and 90-day mortality rates were 0%and 10%,respectively.R0 resection was achieved for all patients,and the median disease-free survival was 18.7 ***:ALPPS is an effective treatment option for advanced *** enables rapid hypertrophy of the FLR and achieves a high R0 resection rate with an acceptable oncological ***,ALPPS should be reserved for selected patients because of its relatively high morbidity and mortality.

关键词： ALPPS Colorectal liver metastasis future liver remnant

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