Extended Liver Venous Deprivation Before Major Hepatectomy Induces Marked and Very Rapid Increase in Future Liver Remnant Function

Overview

Journal Eur Radiol

Specialty Radiology

Date 2017 Jan 20

PMID 28101681

Citations 63

Authors

Boris Guiu

Francois Quenet

Laure Escal

Frederic Bibeau

Lauranne Piron

Philippe Rouanet

Jean-Michel Fabre

Eric Jacquet

Alban Denys

Pierre-Olivier Kotzki

Daniel Verzilli

Emmanuel Deshayes

Affiliations

Soon will be listed here.

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/m). All patients underwent Tc-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).

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