European Radiology

, Volume 27, Issue 8, pp 3343–3352 | Cite as

Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function

  • Boris Guiu
  • François Quenet
  • Laure Escal
  • Frédéric Bibeau
  • Lauranne Piron
  • Philippe Rouanet
  • Jean-Michel Fabre
  • Eric Jacquet
  • Alban Denys
  • Pierre-Olivier Kotzki
  • Daniel Verzilli
  • Emmanuel Deshayes
Interventional

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusions

eLVD is safe and provides a marked and very rapid increase in liver function, unprecedented for an interventional radiology procedure.

Key Points

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)

Keywords

Portal vein embolisation Scintigraphy Liver Surgery Hepatic vein 

Abbreviations

CT

Computed tomography

PVE

portal vein embolisation

FRL

future remnant liver

FRL-V

future remnant liver volume

FRL-F

future remnant liver function

HV

hepatic vein

HVE

hepatic vein embolisation

ALPPS

associating liver partition and portal vein ligation for staged hepatectomy

MHV

middle hepatic vein

PHLF

post-hepatectomy liver failure

LVD

liver venous deprivation

eLVD

extended liver venous deprivation

HBS

hepatobiliary scintigraphy

AST

aspartate aminotransferase

ALT

serum alanine aminotransferase

GGT

gamma-glutamyl-transpeptidase

ALP

alkaline phosphatase

PT

prothrombin time

LDLT

living donor liver transplantation

Notes

Acknowledgements

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

Guarantor

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.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Methodology

• retrospective

• observational study

• performed at one institution

Supplementary material

330_2017_4744_MOESM1_ESM.docx (24 kb)
ESM 1 (DOCX 23 kb)
330_2017_4744_MOESM2_ESM.docx (23 kb)
ESM 2 (DOCX 22 kb)
330_2017_4744_MOESM3_ESM.docx (19 kb)
ESM 3 (DOCX 19 kb)

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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Boris Guiu
    • 1
    • 2
    • 3
  • François Quenet
    • 4
  • Laure Escal
    • 1
  • Frédéric Bibeau
    • 5
  • Lauranne Piron
    • 1
  • Philippe Rouanet
    • 4
  • Jean-Michel Fabre
    • 6
  • Eric Jacquet
    • 7
  • Alban Denys
    • 8
  • Pierre-Olivier Kotzki
    • 2
    • 9
  • Daniel Verzilli
    • 10
  • Emmanuel Deshayes
    • 2
    • 9
  1. 1.Department of RadiologySt-Eloi University HospitalMontpellierFrance
  2. 2.INSERM U1194, Montpellier Cancer Research InstituteMontpellierFrance
  3. 3.Department of RadiologySt-Eloi University HospitalMontpellierFrance
  4. 4.Department of SurgeryInstitut du Cancer de Montpellier (ICM)MontpellierFrance
  5. 5.Department of PathologyInstitut du Cancer de Montpellier (ICM)MontpellierFrance
  6. 6.Department of SurgerySt-Eloi University HospitalMontpellierFrance
  7. 7.Department of SurgeryBeausoleil ClinicMontpellierFrance
  8. 8.Department of RadiologyCHUVLausanneSwitzerland
  9. 9.Department of Nuclear MedicineInstitut du Cancer de Montpellier (ICM)MontpellierFrance
  10. 10.Department of AnesthesiologySt-Eloi University HospitalMontpellierFrance

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