2021•Zeitschrift für GastroenterologieRequires access
Preliminary results on simultaneous portal and hepatic vein embolization prior to major hepatectomy
Shadi Katou, Max Masthoff, Moritz Wildgruber, Michael Köhler, Walter Leonhard Heindel, Christian Wilms, Hartmut Hans-Jürgen Schmidt, B Strücker, Andreas Pascher, Haluk Morgül
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Abstract
Introduction Portal vein embolization (PVE) has been standard procedure for hypertrophy of future remnant liver (FRL) prior to major hepatectomies. However, tumor progress might limit surgery if rapid hypertrophy is not assured. Additional hepatic vein embolization (HVE) obstructs outflow pathway, inhibiting arterial flow and induces further damage to embolized liver area and thereby fosters regeneration of contralateral liver. Methods All consecutive patients undergoing simultaneous right-sided PVE and HVE at our tertiary care centre between 2019 and 2020 were retrospectively included. Underlying malignant identities of patients were cholangiocarcinoma (n = 9), gallbladder cancer (n = 2), colorectal metastases (n = 2), hepatocellular carcinoma (n = 1), Solitary fibrous tumor (n = 1) and melanoma liver metastases (n = 1). FRL and FRL growth rate per day were assessed by volumetry using IntelliSpace Portal station (Philips, Best, The Netherlands) CT viewer software prior and between 13 to 23 days (median 16 days) after PVE and HVE. Further literature based standardised FRL (sFRL), where FRL is calculated in relation to total liver volume based on body surface area (BSA), was calculated with sFRL= FRL/(−794.41+1267.28 × BSA) x 100 with BSA=[weight (kg)×height (cm)/3600]. Results 16 patients (f=6, m=10; age 64.5 years (range 38-82)) were included. Three (19 %) patients received chemotherapy before embolization. Additional embolization of segment IV and middle hepatic vein was conducted in 4 patients (25 %). Mean (±SD) FRL significantly increased from 568.8±148.9 to 832.7±239.6 cm 3 (p < 0.0001). The FRL growth rate per day was 15.1±9.5 cm 3 /d. sFRL significantly increased from 33.0±9.0 to 48.0±12.6 % (p < 0.0001). Conclusion HVE in addition to PVE before major hepatectomy effectively induces FRL growth. HVE should be considered simultaneously to PVE if rapid regeneration is desired. Publication History Article published online: 04 January 2021 © 2020. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany