Article

Increase in future remnant liver function after preoperative portal vein embolization.

Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
British Journal of Surgery (impact factor: 4.61). 06/2011; 98(6):825-34. DOI:10.1002/bjs.7456 pp.825-34
Source: PubMed

ABSTRACT Preoperative portal vein embolization (PVE) is performed in patients with insufficient future remnant liver (FRL) to allow safe resection. Although many studies have demonstrated an increase in FRL volume after PVE, little is known about the increase in FRL function. This study evaluated the increase in FRL function after PVE using (⁹⁹m) Tc-labelled mebrofenin hepatobiliary scintigraphy (HBS) with single photon emission computed tomography (SPECT) and compared this with the increase in FRL volume.
In 24 patients, computed tomography volumetry and (⁹⁹m) Tc-labelled mebrofenin HBS with SPECT were performed before and 3-4 weeks after PVE to measure FRL volume, standardized FRL and FRL function. A hypothetical model was used to assess safe resectability after PVE. The limit for safe resection for FRL function was set at an uptake of 2·69 per cent per min per m². For FRL volume and standardized FRL, 25 or 40 per cent of total liver volume was used, depending on the presence of underlying liver disease.
After PVE, FRL function increased significantly more than FRL volume. The correlation between the increase in FRL volume and FRL function was poor. Using the hypothetical model, seven patients did not achieve a sufficient increase in FRL function to allow safe resection 3-4 weeks after PVE, compared with 12 and nine patients based on FRL volume and standardized FRL respectively.
The increase in FRL function after PVE is more pronounced than the increase in FRL volume, suggesting that the necessary waiting time until resection may be shorter than indicated by volumetric parameters.

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    Article: Liver remnant hypertrophy induction - how often do we really use it in the time of computer assisted surgery?
    Ga Stavrou, M Donati, Ki Ringe, Ho Peitgen, Kj Oldhafer
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    ABSTRACT: ABSTRACT Purpose: To evaluate the significance of the hypertrophy concept in patients requiring extended liver resections for colorectal metastasis in the time of computer assisted surgery. Methods: Retrospective analysis of patient collective undergoing major liver surgery. 2D CT, 3D CAS with Fraunhofer MeVis Sofware. Portal vein embolisation (PVE) with the Amplazer Plug, portal vein ligation (PVL) as 1. Stage operative procedure. Results: 2D CT data identified 29 patients out of 319 (2002-2009) to be at risk for liver failure after resection. After 3D CAS analysis and virtual operation planning, only 7/29 were at true risk and were submitted to portal vein occlusion (PVO). Another 5 patients were submitted to the hypertrophy concept for intraoperative finding of insufficient parenchyma quality. In total, 12 patients underwent PVO (6 PVE/6 PVL). 9/12 patients went to stage 2 and were successfully operated. There was no difference in future remnant liver volume (FRLV) gain or waiting time to step 2 between the groups, though survival was better in the PVE group. Conclusion: PVO is an effective approach if the patient's future remnant liver (FRL) is too small on 2D CT volumetry. 3D CAS has great impact on the analysis of FRL capacity and in augmenting resectability - in our experience only patients with insufficient FRLV on the virtual resection plan have to take the risk of PVO to maintain the chance of liver resection.
    Advances in Medical Sciences 01/2013;
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Keywords

3-4 weeks
 
cent
 
computed tomography volumetry
 
FRL
 
FRL function
 
FRL volume
 
hypothetical model
 
insufficient future remnant liver
 
liver disease
 
measure FRL volume
 
Preoperative portal vein embolization
 
safe resectability
 
safe resection
 
safe resection 3-4 weeks
 
single photon emission computed tomography
 
standardized FRL
 
sufficient increase
 
total liver volume
 
uptake
 
volumetric parameters