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The extent of liver resection is limited by the residual functional reserve of the liver (FLR). The introduction of portal vein embolization (PVE), with the rationale of inducing hypertrophy of the FLR has significantly reduced morbidity and in particular the impact of postoperative liver failure (PLF). The objective of the study is to evaluate the feasibility and effectiveness of PVE in patients candidates to liver resections with high risk of PLF. Between January 2006 and December 2009, 62 patients suffering from primary or metastatic liver tumour, underwent PVE at the Department of Surgery-Liver Unit HSR. CT assessment of hepatic volume was performed in each patient, prior and 4 weeks after the procedure. The outcome was evaluated in terms of feasibility of surgery, FLR growth [calculated as: (FLR after PVE - FLR pre PVE) × 100/FLR pre PVE], morbidity and mortality associated with PVE and surgery. Of the 62 patients undergoing PVE, 6 (9.7%) did not benefit from surgery: of these, 4 showed spread of disease in the FLR at CT control, while in the remaining 2 adequate hypertrophy was not reached. The average volume of the FLR at the time of the procedure and after 4 weeks was 437.03 cc (±172.54) and 615.15 cc (± 187.49), respectively, with an average increase of 50.3% (±30.31). During the postoperative period, only 2 patients (3.2%) showed mild and transient signs of the PLF. The technique of PVE allows to performing, in an effective and safe way, major liver resections in patients with high risk of PLF.
Dipartimento di Chirurgia Generale e Specialistica, Unità Operativa Complessa Chirurgia Epatobiliare, Liver Unit, IRCCS H San Raffaele, Università Vita-Salute S. Raffaele, Via Olgettina 60, 20132, Milan, Italy, firstname.lastname@example.org.
This article was published in the following journal.
Name: Updates in surgery
The aim of this study was to compare arterial embolization (AE) with portal vein embolization (PVE) for the induction of segmental hypertrophy regarding procedural efficacy, safety and outcome.
Efficacy of Preoperative Portal Vein Embolization Among Patients with Hepatocellular Carcinoma, Biliary Tract Cancer, and Colorectal Liver Metastases: A Comparative Study Based on Single-Center Experience of 319 Cases.
Efficacy of preoperative portal vein embolization (PVE) has been established; however, differences of outcomes among diseases, including hepatocellular carcinoma (HCC), biliary tract cancer (BTC), and...
Portal vein embolization (PVE) is increasingly performed worldwide to reduce the possibility of liver failure after extended hepatectomy, by inducing future liver remnant (FLR) hypertrophy and atrophy...
To assess frequency of adverse events, efficacy, and clinical outcomes of percutaneous portal vein embolization (PVE) in patients with bilobar colorectal liver metastases undergoing staged hepatectomy...
Despite a fast and potent growth of the future liver remnant (FLR), patients operated with associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are at risk of developing...
RATIONALE: Embolization blocks blood flow to part of an organ and/or tumor. Blocking the portal vein on one side of the liver may cause the opposite side of the liver to increase in size a...
The aim of this study is to prospectively evaluate the tolerance and efficiency of a new technique of preoperative selective portal vein embolization (PVE) in patients requiring major hepa...
Post-hepatectomy liver failure is one of the most feared complications by hepatic surgeons. When size of the future liver remnant (FLR) is regarded to be not sufficient to sustain post-hep...
The investigators hypothesize that 4Dimensional Phase Contrast Magnetic Resonance Angiography (4D PC MRA) evaluation of portal venous flow predicts underlying liver function and hypertroph...
Islet transplantation is one of the effective and promising options for type 1 diabetes mellitus treatment1-4. The liver is the primary target location for infusion and portal vein cathete...
Abnormal increase of resistance to blood flow within the hepatic PORTAL SYSTEM, frequently seen in LIVER CIRRHOSIS and conditions with obstruction of the PORTAL VEIN.
A short thick vein formed by union of the superior mesenteric vein and the splenic vein.
Veins which return blood from the intestines; the inferior mesenteric vein empties into the splenic vein, the superior mesenteric vein joins the splenic vein to form the portal vein.
A type of surgical portasystemic shunt to reduce portal hypertension with associated complications of esophageal varices and ascites. It is performed percutaneously through the jugular vein and involves the creation of an intrahepatic shunt between the hepatic vein and portal vein. The channel is maintained by a metallic stent. The procedure can be performed in patients who have failed sclerotherapy and is an additional option to the surgical techniques of portocaval, mesocaval, and splenorenal shunts. It takes one to three hours to perform. (JAMA 1995;273(23):1824-30)
Liver disease caused by infections with parasitic tapeworms of the genus ECHINOCOCCUS, such as Echinococcus granulosus or Echinococcus multilocularis. Ingested Echinococcus ova burrow into the intestinal mucosa. The larval migration to the liver via the PORTAL VEIN leads to watery vesicles (HYDATID CYST).
Hepatology is the study of liver, gallbladder, biliary tree, and pancreas, and diseases associated with them. This includes viral hepatitis, alcohol damage, cirrhosis and cancer. As modern lifestyles change, with alcoholism and cancer becoming more promi...