Background: To report our preliminary experience with preoperative portal vein embolization (PVE) using liquid ethylene vinyl alcohol (EVOH) copolymer.
Methods: Retrospectively review of patients with primary or secondary liver malignancies scheduled for extensive hepatectomy after the induction of future liver remnant (FLR) hypertrophy by right or left PVE with EVOH as the only embolic agent between 2014 and 2018 at two academic centers. Cross-sectional imaging liver volumetry data obtained before and 3-6 weeks after PVE were used to assess the FLR volume (FLRV) increase, degree of FLR hypertrophy and the FLR kinetic growth rate (KGR).
Results: Twenty-six patients (17 males; mean age, 58.7±11 years; range, 32-79 years) were included. The technical and clinical success rate was 100%. PVE produced adequate FLR hypertrophy in all patients. Embolization occurred in all targeted portal branches and in no non-target vessels. The %FLRV increased by 52.9%±32.5% and the degree of FLR hypertrophy was 16.7%±6.8%. The KGR was 4.4%±2.0% per week. Four patients experience minor complications after PVE which resolved with symptomatic treatment. The resection rate was 84.5%. One patient died during surgery for reasons unrelated to PVE.
Conclusions: Preoperative PVE with EVOH copolymer is feasible, safe, and effective in inducing FLR hypertrophy.
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http://dx.doi.org/10.21037/qims-20-808 | DOI Listing |
Clin Radiol
November 2024
Department of Medical Imaging and Interventions, Chang Gung Memorial Hospital at Linkou, 5 FuXing Road, Guishan District, Taoyuan, 333, Taiwan. Electronic address:
Aim: Compare the efficacy and procedural efficiency of central vascular plug-assisted portal vein embolization (PVE) with absolute ethanol compared to selective PVE.
Materials And Methods: Between 2016 and 2023, patients who underwent ipsilateral percutaneous transhepatic PVE were included. Selective PVE involves serial cannulation and embolization of portal veins.
Hepatobiliary Surg Nutr
December 2024
Hepatobiliary and Pancreatic Surgery Department, CHU de Bordeaux, Pessac, France.
Background: Post-hepatectomy liver failure (PHLF) is the first cause of death after major hepatectomy, and future liver remnant (FLR) volume is the main factor predicting PHLF. Liver venous deprivation (LVD) via portal and hepatic vein embolization has been suggested to induce a better hypertrophy of the FLR than portal vein embolization. The aim of this retrospective multicentric study was to assess safety, feasibility and efficacity of LVD in a French national multicentric register.
View Article and Find Full Text PDFAnn Surg Oncol
December 2024
Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Objectives: This study aimed to develop and externally validate a model for predicting insufficient future liver remnant (FLR) hypertrophy after portal vein embolization (PVE) based on clinical factors and radiomics of pretreatment computed tomography (CT) PATIENTS AND METHODS: Clinical information and CT scans of 241 consecutive patients from three Swedish centers were retrospectively collected. One center (120 patients) was applied for model development, and the other two (59 and 62 patients) as test cohorts. Logistic regression analysis was adopted for clinical model development.
View Article and Find Full Text PDFAnn Surg Oncol
December 2024
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Background: Liver venous deprivation (LVD) is known to induce better future liver remnant (FLR) hypertrophy than portal vein embolization (PVE). The role of LVD, compared with PVE, in inducing FLR hypertrophy and allowing safe hepatectomy for patients with extensive colorectal liver metastases (CLM) and high-risk factors for inadequate hypertrophy remains unclear.
Methods: Patients undergoing LVD (n = 22) were matched to patients undergoing PVE (n = 279) in a 1:3 ratio based on propensity scores, prior to planned hepatectomy for CLM at a single center (1998-2023).
J Gastrointest Oncol
October 2024
Department of Hepatic Surgery, First People's Hospital of Foshan, Foshan, China.
Background: Hepatocellular carcinoma (HCC) is currently one of the most common malignant tumors with the highest mortality rates in the world. Most patients with HCC have lost the opportunity for surgery at the time of initial diagnosis. This study aims to introduce a new conversion strategy: trans-arterial chemo-emobilization (TACE) combined with laparoscopic portal vein ligation (PVL) and terminal branches portal vein embolization (PVE).
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