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Volumetric and functional recovery of the remnant liver after major liver resection with prior portal vein embolization : recovery after PVE and liver resection.

van den Esschert JW, de Graaf W, van Lienden KP, Busch OR, Heger M, van Delden OM, Gouma DJ, Bennink RJ, Laméris JS, van Gulik TM - J. Gastrointest. Surg. (2009)

Bottom Line: Groups were comparable for gender, age, and number of patients with a compromised liver.Prior to surgery, there were no significant differences in future remnant liver volume and function between the groups.Remnant liver function increased up to 88.1 +/- 17.4% and 83.3 +/- 14% respectively of the original total liver function (p > 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Academic Medical Center, IWO-1, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.

ABSTRACT

Introduction: Portal vein embolization is an accepted method to increase the future remnant liver preoperatively. The aim of this study was to assess the effect of preoperative portal vein embolization on liver volume and function 3 months after major liver resection.

Materials and methods: This is a retrospective case-control study. Data were collected of patients who underwent portal vein embolization prior to (extended) right hemihepatectomy and of control patients who underwent the same type of resection without prior portal vein embolization. Liver volumes were measured by computed tomography volumetry before portal vein embolization, before liver resection, and 3 months after liver resection. Liver function was assessed by hepatobiliary scintigraphy before and 3 months after liver resection.

Results: Ten patients were included in the embolization group and 13 in the control group. Groups were comparable for gender, age, and number of patients with a compromised liver. The mean future remnant liver volume was 33.0 +/- 8.0% prior to portal vein embolization in the embolization group and 45.6 +/- 9.1% in the control group (p < 0.01). Prior to surgery, there were no significant differences in future remnant liver volume and function between the groups. Three months postoperatively, the mean remnant liver volume was 81.9 +/- 8.9% of the initial total liver volume in the embolization group and 79.4 +/- 11.0% in the control group (p > 0.05). Remnant liver function increased up to 88.1 +/- 17.4% and 83.3 +/- 14% respectively of the original total liver function (p > 0.05).

Conclusion: Preoperative portal vein embolization does not negatively influence postoperative liver regeneration assessed 3 months after major liver resection.

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Related in: MedlinePlus

CT cross section of the liver showing total liver (yellow delineation) and the future remnant liver (red delineation). CT volumetry showed that the future remnant liver was markedly increased 3 weeks after portal vein embolization (pre-op, 507 ml) compared to before portal vein embolization (pre-PVE, 392 ml). Three months after partial liver resection, the remnant liver volume almost reached its original total liver volume. For interpretation of the references to color in this figure legend, the reader is referred to the online version of this article.
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Fig1: CT cross section of the liver showing total liver (yellow delineation) and the future remnant liver (red delineation). CT volumetry showed that the future remnant liver was markedly increased 3 weeks after portal vein embolization (pre-op, 507 ml) compared to before portal vein embolization (pre-PVE, 392 ml). Three months after partial liver resection, the remnant liver volume almost reached its original total liver volume. For interpretation of the references to color in this figure legend, the reader is referred to the online version of this article.

Mentions: Liver volumes were measured using CT. The total liver, the FRL, and tumor mass were manually delineated on each 5-mm slide of the portal phase images. The TLV, tumor volume (TV), and FRLV were calculated using dedicated software (Mx-View 3.52, Philips Medical Systems, The Netherlands; Fig. 1). The percentage FRLV before PVE was calculated by:14\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\% {\text{FRLV}}{}_{{{\text{pre - PVE}}}} = {\left( {\frac{{{\text{FRLV}}_{{{\text{pre - PVE}}}} }}{{{\left( {{\text{TLV - TV}}} \right)}_{{{\text{pre - PVE}}}} }}} \right)}\; \times \;100\% .$$\end{document}Figure 1


Volumetric and functional recovery of the remnant liver after major liver resection with prior portal vein embolization : recovery after PVE and liver resection.

van den Esschert JW, de Graaf W, van Lienden KP, Busch OR, Heger M, van Delden OM, Gouma DJ, Bennink RJ, Laméris JS, van Gulik TM - J. Gastrointest. Surg. (2009)

CT cross section of the liver showing total liver (yellow delineation) and the future remnant liver (red delineation). CT volumetry showed that the future remnant liver was markedly increased 3 weeks after portal vein embolization (pre-op, 507 ml) compared to before portal vein embolization (pre-PVE, 392 ml). Three months after partial liver resection, the remnant liver volume almost reached its original total liver volume. For interpretation of the references to color in this figure legend, the reader is referred to the online version of this article.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710489&req=5

Fig1: CT cross section of the liver showing total liver (yellow delineation) and the future remnant liver (red delineation). CT volumetry showed that the future remnant liver was markedly increased 3 weeks after portal vein embolization (pre-op, 507 ml) compared to before portal vein embolization (pre-PVE, 392 ml). Three months after partial liver resection, the remnant liver volume almost reached its original total liver volume. For interpretation of the references to color in this figure legend, the reader is referred to the online version of this article.
Mentions: Liver volumes were measured using CT. The total liver, the FRL, and tumor mass were manually delineated on each 5-mm slide of the portal phase images. The TLV, tumor volume (TV), and FRLV were calculated using dedicated software (Mx-View 3.52, Philips Medical Systems, The Netherlands; Fig. 1). The percentage FRLV before PVE was calculated by:14\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\% {\text{FRLV}}{}_{{{\text{pre - PVE}}}} = {\left( {\frac{{{\text{FRLV}}_{{{\text{pre - PVE}}}} }}{{{\left( {{\text{TLV - TV}}} \right)}_{{{\text{pre - PVE}}}} }}} \right)}\; \times \;100\% .$$\end{document}Figure 1

Bottom Line: Groups were comparable for gender, age, and number of patients with a compromised liver.Prior to surgery, there were no significant differences in future remnant liver volume and function between the groups.Remnant liver function increased up to 88.1 +/- 17.4% and 83.3 +/- 14% respectively of the original total liver function (p > 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Academic Medical Center, IWO-1, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.

ABSTRACT

Introduction: Portal vein embolization is an accepted method to increase the future remnant liver preoperatively. The aim of this study was to assess the effect of preoperative portal vein embolization on liver volume and function 3 months after major liver resection.

Materials and methods: This is a retrospective case-control study. Data were collected of patients who underwent portal vein embolization prior to (extended) right hemihepatectomy and of control patients who underwent the same type of resection without prior portal vein embolization. Liver volumes were measured by computed tomography volumetry before portal vein embolization, before liver resection, and 3 months after liver resection. Liver function was assessed by hepatobiliary scintigraphy before and 3 months after liver resection.

Results: Ten patients were included in the embolization group and 13 in the control group. Groups were comparable for gender, age, and number of patients with a compromised liver. The mean future remnant liver volume was 33.0 +/- 8.0% prior to portal vein embolization in the embolization group and 45.6 +/- 9.1% in the control group (p < 0.01). Prior to surgery, there were no significant differences in future remnant liver volume and function between the groups. Three months postoperatively, the mean remnant liver volume was 81.9 +/- 8.9% of the initial total liver volume in the embolization group and 79.4 +/- 11.0% in the control group (p > 0.05). Remnant liver function increased up to 88.1 +/- 17.4% and 83.3 +/- 14% respectively of the original total liver function (p > 0.05).

Conclusion: Preoperative portal vein embolization does not negatively influence postoperative liver regeneration assessed 3 months after major liver resection.

Show MeSH
Related in: MedlinePlus