Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function
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.
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.
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.
eLVD is safe and provides a marked and very rapid increase in liver function, unprecedented for an interventional radiology procedure.
• 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)
KeywordsPortal vein embolisation Scintigraphy Liver Surgery Hepatic vein
portal vein embolisation
future remnant liver
future remnant liver volume
future remnant liver function
hepatic vein embolisation
associating liver partition and portal vein ligation for staged hepatectomy
middle hepatic vein
post-hepatectomy liver failure
liver venous deprivation
extended liver venous deprivation
serum alanine aminotransferase
living donor liver transplantation
The authors thank Dr. Hélène de Forges for editing and writing assistance, Dr. Julie Carr for revising the English, Dr. Raphael Tetreau for the CT-scan acquisitions and Prof. Samir Jaber for his helpful assistance.
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Boris Guiu.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
The authors state that this work has not received any funding.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Institutional Review Board approval was obtained.
Written informed consent was waived by the Institutional Review Board.
• observational study
• performed at one institution
- 16.Petrowsky H (2016) Does volume translate in function in interstage associating liver partition and portal vein ligation for staged hepatectomy?: Commentary on "Drop of total liver function in the interstages of the new associating liver partition and portal vein ligation for staged hepatectomy technique: analysis of the auxiliary liver by hepatobiliary iminodiacetic acid scintigraphy". Ann Surg 263, e35CrossRefPubMedGoogle Scholar
- 19.Oldhafer F, Ringe KI, Timrott K et al (2016) Monitoring of liver function in a 73-year old patient undergoing 'Associating Liver Partition and Portal vein ligation for Staged hepatectomy': case report applying the novel liver maximum function capacity test. Patient Saf Surg 10:16CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Shindoh J, Vauthey JN, Zimmitti G et al (2013) Analysis of the efficacy of portal vein embolization for patients with extensive liver malignancy and very low future liver remnant volume, including a comparison with the associating liver partition with portal vein ligation for staged hepatectomy approach. J Am Coll Surg 217:126–133, discussion 133-124CrossRefPubMedGoogle Scholar
- 32.Ko GY, Hwang S, Sung KB, Gwon DI, Lee SG (2010) Interventional oncology: new options for interstitial treatments and intravascular approaches: right hepatic vein embolization after right portal vein embolization for inducing hypertrophy of the future liver remnant. J Hepatobiliary Pancreat Sci 17:410–412CrossRefPubMedGoogle Scholar