Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique

Autor: Guillaume Baudin, François Quenet, Alban Denys, M A Pierredon-Foulongne, Astrid Herrero, Patrick Chevallier, Jeanne Ramos, Boris Guiu, Fabrizio Panaro, Jean-Michel Fabre, E. Delhom, Philippe Rouanet
Přispěvatelé: Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle (ICM), CRLCC Val d'Aurelle - Paul Lamarque, Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Male
[SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging
medicine.medical_treatment
Portal venous pressure
Gastroenterology
030218 nuclear medicine & medical imaging
Muscle hypertrophy
0302 clinical medicine
Liver Function Tests
Embolization
Portal Vein Embolization
medicine.diagnostic_test
Portal Vein
Liver Neoplasms
General Medicine
Middle Aged
Embolization
Therapeutic
3. Good health
medicine.anatomical_structure
Treatment Outcome
Liver
030220 oncology & carcinogenesis
Hepatocellular carcinoma
Hepatic Vein
Female
Radiology
Adult
medicine.medical_specialty
Histology
[SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine
Hepatic Veins
03 medical and health sciences
Atrophy
Internal medicine
Preoperative Care
medicine
Hepatectomy
Humans
Radiology
Nuclear Medicine and imaging
Vein
Aged
business.industry
medicine.disease
Bile Duct Neoplasms
Feasibility Studies
Surgery
business
Liver function tests
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Zdroj: European Radiology
European Radiology, Springer Verlag, 2016, 26 (12), pp.4259-4267. ⟨10.1007/s00330-016-4291-9⟩
ISSN: 0938-7994
1432-1084
DOI: 10.1007/s00330-016-4291-9⟩
Popis: International audience; PURPOSE:To assess technical feasibility, safety, and efficacy of the liver venous deprivation (LVD) technique that combines both portal and hepatic vein embolization during the same procedure for liver preparation before major hepatectomy.MATERIALS AND METHODS:Seven patients (mean age:63.6y[42-77y]) underwent trans-hepatic LVD for liver metastases (n = 2), hepatocellular carcinoma (n = 1), intrahepatic cholangiocarcinoma (n = 3) and Klatskin tumour (n = 1). Assessment of future remnant liver (FRL) volume, liver enzymes and histology was performed.RESULTS:Technical success was 100 %. No complication occurred before surgery. Resection was performed in 6/7 patients. CT-scan revealed hepatic congestion in the venous-deprived area (6/7 patients). A mean of 3 days (range: 1-8 days) after LVD, transaminases increased (AST: from 42 ± 24U/L to 103 ± 118U/L, ALT: from 45 ± 25U/L to 163 ± 205U/L). Twenty-three days (range: 13-30 days) after LVD, FRL increased from 28.2 % (range: 22.4-33.3 %) to 40.9 % (range: 33.6-59.3 %). During the first 7 days, venous-deprived liver volume increased (+13.4 %) probably reflecting vascular congestion, whereas it strongly decreased (-21.3 %) at 3-4 weeks. Histology (embolized lobe) revealed sinusoidal dilatation, hepatocyte necrosis and important atrophy in all patients.CONCLUSION:Trans-hepatic LVD technique is feasible, well tolerated and provides fast and important hypertrophy of the FRL. This new technique needs to be further evaluated and compared to portal vein embolization.KEY POINTS:• Twenty-three days after LVD, FRL increased from 28.2 % (range:22.4-33.3 %) to 40.9 % (range:33.6-59.3 %) • During the first 7 days, venous-deprived liver volume increased (+13.4 %) • Venous-deprived liver volume strongly decreased (mean atrophy:229 cc; -21.3 %) at 3-4 weeks • Histology of venous-deprived liver revealed sinusoidal dilatation, hepatocyte necrosis and important atrophy.
Databáze: OpenAIRE
Externí odkaz: