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. 2017 Aug;27(8):3343-3352.
doi: 10.1007/s00330-017-4744-9. Epub 2017 Jan 18.

Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function

Boris Guiu  1   2   3 , François Quenet  4 , Laure Escal  5 , Frédéric Bibeau  6 , Lauranne Piron  5 , Philippe Rouanet  4 , Jean-Michel Fabre  7 , Eric Jacquet  8 , Alban Denys  9 , Pierre-Olivier Kotzki  10   11 , Daniel Verzilli  12 , Emmanuel Deshayes  10   11
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Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function

Boris Guiu et al. Eur Radiol. 2017 Aug.

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/m2). All patients underwent 99mTc-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).

Keywords: Hepatic vein; Liver; Portal vein embolisation; Scintigraphy; Surgery.

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