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Welcker K, Schneider MA, Reese T, Ehrenfeld A, Weilert H, Stang A, Wohlmuth P, Warnke MM, Reiner C, von Hahn T, Oldhafer KJ, Mahnken AH, Brüning R. Negative impact of chemotherapy on kinetic growth rate of the future liver remnant if applied following PVE or ALPPS. PLoS One 2025; 20:e0307937. [PMID: 40053536 PMCID: PMC11888131 DOI: 10.1371/journal.pone.0307937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 07/15/2024] [Indexed: 03/09/2025] Open
Abstract
PURPOSE Modern liver surgery has improved the percentage of potentially resectable malignant tumors. However, if the future liver remnant is small, patients remain at risk of developing postoperative liver failure. Thus, the future liver remnant must be increased, while at the same time, the primary tumor may have to be controlled by chemotherapy. To address this conflict, we retrospectively analyzed the changes in hypertrophy before and after Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) or Portal Vein Embolization (PVE), with or without parallel systemic chemotherapy. MATERIALS AND METHODS We retrospectively analysed 172 patients (54 female and 118 male), treated with ALPPS in 90 patients (median age 61 years [Q1, Q3: 52,71]) and with PVE in 82 patients (median age 66 years [Q1, Q3: 56,73]). The median control interval was 4.9 [Q1, Q3: 4.0, 6.0] weeks after the PVE, and 2.6 [Q1, Q3: 1.6, 5.8] weeks after ALPPS step 1. RESULTS The overall kinetic growth rate (median) for the entire group was 0.02 (2%) per week. When systemic chemotherapy was administered prior to intervention, the kinetic growth rate of these treated patients (vs. untreated) exhibited a median of 0.020 [Q1, Q3: 0.011, 0.067] compared to 0.024 [Q1, Q3: 0.013, 0.041] (p = 0.949). When chemotherapy was administered after the PVE/ ALPPS treatment, the kinetic growth rate declined from a median of 0.025 [Q1, Q3: 0.013, 0.053] to 0.011 [Q1, Q3: 0.007, 0.021] (p = 0.005). Subgroup analysis showed statistically significant effects only in the PVE group (median ALPPS -45% (p = 0.157), PVE -47% (p = 0.005)). CONCLUSION This retrospective analysis indicated that systemic chemotherapy given after PVE/ the first step of the ALPPS procedure, i.e., the growth phase, has a negative effect on the kinetic growth rate.
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Affiliation(s)
- Klara Welcker
- Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany
- Department of Surgery, Division of Liver-, Bileduct- and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany
| | | | - Tim Reese
- Department of Surgery, Division of Liver-, Bileduct- and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Andrea Ehrenfeld
- Gastroenterology, Hepatology and interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Hauke Weilert
- Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Axel Stang
- Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
- Clinic for Diagnostic and Interventional Radiology, Philipps University and University Clinic Marburg, Marburg, Germany
| | - Peter Wohlmuth
- Medical Faculty, Semmelweis University Budapest, Hamburg, Germany,
| | - Mia-Maria Warnke
- Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Carolin Reiner
- Clinic for Diagnostic and Interventional Radiology, Philipps University and University Clinic Marburg, Marburg, Germany
| | - Thomas von Hahn
- Gastroenterology, Hepatology and interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Clinic for Diagnostic and Interventional Radiology, Philipps University and University Clinic Marburg, Marburg, Germany
| | - Karl J. Oldhafer
- Gastroenterology, Hepatology and interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany
- Clinic for Diagnostic and Interventional Radiology, Philipps University and University Clinic Marburg, Marburg, Germany
| | | | - Roland Brüning
- Radiology and Neuroradiology, Asklepios Hospital Barmbek, Hamburg, Germany
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Zhang S, Song R, Hou C, Yao H, Xu J, Zhou H, Li S, Cai W, Fei Y, Meng F, Yin D, Wang J, Zhang S, Liu Y, Wang J, Liu L. Simultaneous Liver Venous Deprivation Following Hepatic Arterial Chemoembolization Before Major Hepatectomy for Hepatocellular Carcinoma: A New Methods to Achieve Hypertrophy Liver Remnant. J Hepatocell Carcinoma 2025; 12:219-229. [PMID: 39931181 PMCID: PMC11808792 DOI: 10.2147/jhc.s495304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 01/19/2025] [Indexed: 02/13/2025] Open
Abstract
Purpose Liver venous deprivation (LVD; simultaneous portal vein embolization and hepatic vein embolization) has been the latest surgical strategy for rapid future liver remnant (FLR) hypertrophy. The aim of this study was to assess the feasibility, safety, and efficacy of simultaneous LVD following hepatic arterial chemoembolization (TACE-LVD) before major hepatectomy for hepatocellular carcinoma (HCC). Patients and Methods A retrospective analysis of the outcomes of 23 HCC patients who underwent TACE-LVD at our center between October 2019 and October 2023 was conducted. An assessment of postoperative complications, FLR volume, liver function, and tumor response was performed. Results All patients successfully underwent TACE-LVD. No other serious complications occurred except in 1 patient who underwent puncture drainage due to excessive pleural effusion. Following TACE-LVD, transaminase levels peak two days before rapidly decreasing and return to preoperative levels within one week. The ratio of FLR to standardized liver volume increased from 35.9% (interquartile range [IQR], 8.6) to 46.4% (IQR, 8.2), with a mean degree of hypertrophy and kinetic growth rate of 13.2% (IQR, 5.4) and 4.4% (IQR, 1.8) per week, respectively. At the first assessment after TACE-LVD, most patients exhibited sufficient FLR for hepatectomy, except for 4 patients with cirrhosis. The modified response evaluation criteria for solid tumor assessment revealed a disease control rate of 95.7%, with only 1 patient (Barcelona Clinic Liver Cancer stage C) developing intrahepatic disease progression. Conclusion TACE-LVD seems to be a feasible, safe, and effective strategy for rapid FLR hypertrophy. Moreover, TACE-LVD may be a therapeutic choice if insufficient FLR hypertrophy precludes resection. This strategy warrants further exploration.
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Affiliation(s)
- Shenyu Zhang
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
| | - Ruipeng Song
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
| | - Changlong Hou
- Department of Intervention, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Huanzhang Yao
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
| | - Jun Xu
- Department of Intervention, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Hangcheng Zhou
- Department of Pathology, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Shaopeng Li
- Department of Imaging, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Wei Cai
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
| | - Yipeng Fei
- Department of Intervention, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People’s Republic of China
| | - Fanzheng Meng
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
| | - Dalong Yin
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
| | - Jiabei Wang
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
| | - Shugeng Zhang
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
| | - Yao Liu
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
| | - Jizhou Wang
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
- Anhui Provincial Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, 230001, People’s Republic of China
- Anhui Provincial Clinical Research Center for Hepatobiliary Diseases, Hefei, Anhui, 230001, People’s Republic of China
| | - Lianxin Liu
- Department of Hepatobiliary Surgery, Centre for Leading Medicine and Advanced Technologies of IHM, the first affiliated hospital of ustc, Division of Life Sciences and Medicine, university of science and technology of china, Hefei, Anhui, 230001, People’s Republic of China
- Anhui Provincial Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, 230001, People’s Republic of China
- Anhui Provincial Clinical Research Center for Hepatobiliary Diseases, Hefei, Anhui, 230001, People’s Republic of China
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Boubaddi M, Marichez A, Pecquenard F, Maulat C, Buc E, Sulpice L, Ayav A, Truant S, Muscari F, Chiche L, Laurent C. Liver venous deprivation (LVD) before extended hepatectomy: a French multicentric retrospective cohort. Hepatobiliary Surg Nutr 2024; 13:937-949. [PMID: 39669088 PMCID: PMC11634414 DOI: 10.21037/hbsn-24-315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/21/2024] [Indexed: 12/14/2024]
Abstract
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. Methods Between 2016 and 2023, LVD was performed in 7 expert centers, for patients with liver malignancies requiring major hepatectomy with an FLR percentage of total liver volume (FLR%) ≤25% for a healthy liver or <30% for a diseased liver. FLR volumetry was assessed before and 4 weeks after the procedure. Results One hundred and ninety-two patients were included in the study. The technical success rate was 100% and severe complication rate post-LVD was 2.6% (5/192). The FLR% increased by 61.7% over an average of 27±9.7 days. Major hepatectomy was performed 40 days after LVD on 161 (83.8%) patients. Hepatectomy was not performed on 31 (16.2%) patients, mostly because of oncological progression. Severe postoperative complications (Clavien-Dindo grade ≥ IIIA) occurred in 21.1% (34/161) of patients. Postoperative mortality rate was 4.3% (7/161). Conclusions This study is the largest to confirm that LVD is a safe, reproducible, efficient technique that induces rapid major FLR growth. However, this new technique needs to be standardized and harmonized between centers to ensure uniform results.
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Affiliation(s)
- Mehdi Boubaddi
- Hepatobiliary and Pancreatic Surgery Department, CHU de Bordeaux, Pessac, France
| | - Arthur Marichez
- Hepatobiliary and Pancreatic Surgery Department, CHU de Bordeaux, Pessac, France
| | - Florian Pecquenard
- Hepatobiliary and Pancreatic Surgery Department, CHU de Lilles, Lille, France
| | - Charlotte Maulat
- Hepatobiliary and Pancreatic Surgery Department, CHU de Toulouse, Toulouse, France
| | - Emmanuel Buc
- Hepatobiliary and Pancreatic Surgery Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurent Sulpice
- Hepatobiliary and Pancreatic Surgery Department, CHU de Rennes, Rennes, France
| | - Ahmet Ayav
- Hepatobiliary and Pancreatic Surgery Department, CHU de Nancy, Nancy, France
| | - Stéphanie Truant
- Hepatobiliary and Pancreatic Surgery Department, CHU de Lilles, Lille, France
| | - Fabrice Muscari
- Hepatobiliary and Pancreatic Surgery Department, CHU de Toulouse, Toulouse, France
| | - Laurence Chiche
- Hepatobiliary and Pancreatic Surgery Department, CHU de Bordeaux, Pessac, France
| | - Christophe Laurent
- Hepatobiliary and Pancreatic Surgery Department, CHU de Bordeaux, Pessac, France
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Moaven O, Mainali BB, Valenzuela CD, Russell G, Cheung T, Corvera CU, Wisneski AD, Cha CH, Stauffer JA, Shen P. Prognostic implications of margin status in association with systemic treatment in a cohort study of patients with resection of colorectal liver metastases. J Surg Oncol 2024; 130:1654-1661. [PMID: 39183490 DOI: 10.1002/jso.27846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND This study investigates the impact of margin status after colorectal liver metastasis (CLM) resection on outcomes of patients after neoadjuvant treatment versus those who underwent upfront resection. METHODS An international collaborative database of CLM patients who underwent surgical resection was used. Proportional hazard regression models were created for single and multivariable models to assess the relationship between independent measures and median overall survival (mOS). RESULTS R1 was associated with worse OS in the neoadjuvant group (mOS: 51.8 m for R0 vs. 26.0 m for R1; HR: 2.18). In the patients who underwent upfront surgery, R1 was not associated with OS. (mOS: 46.7 m for R0 vs. 42.6 m for R1). When patients with R1 in each group were stratified by adjuvant treatment, there was no significant difference in the neoadjuvant group, while in the upfront surgery group with R1, adjuvant treatment was associated with significant improvement in OS (mOS: 42.6 m for adjuvant vs. 25.0 m for no adjuvant treatment; HR: 0.21). CONCLUSION R1 is associated with worse outcomes in the patients who receive neoadjuvant treatment with no significant improvement with the addition of adjuvant therapy, likely representing an aggressive tumor biology. R1 did not impact OS in patients with upfront surgery who received postoperative chemotherapy.
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Affiliation(s)
- Omeed Moaven
- Division of Surgical Oncology, Department of Surgery, Louisiana State University (LSU) Health, New Orleans, Louisiana, USA
- LSU-LCMC Cancer Center, New Orleans, Louisiana, USA
| | - Bigyan B Mainali
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Gregory Russell
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Tanto Cheung
- Department of Surgery, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Carlos U Corvera
- Department of Hepatobiliary & Pancreatic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Andrew D Wisneski
- Department of Hepatobiliary & Pancreatic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Charles H Cha
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - John A Stauffer
- Department of Surgical Oncology, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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Boubaddi M, Marichez A, Adam JP, Lapuyade B, Debordeaux F, Tlili G, Chiche L, Laurent C. Comprehensive Review of Future Liver Remnant (FLR) Assessment and Hypertrophy Techniques Before Major Hepatectomy: How to Assess and Manage the FLR. Ann Surg Oncol 2024; 31:9205-9220. [PMID: 39230854 DOI: 10.1245/s10434-024-16108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/16/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND The regenerative capacities of the liver and improvements in surgical techniques have expanded the possibilities of resectability. Liver resection is often the only curative treatment for primary and secondary malignancies, despite the risk of post-hepatectomy liver failure (PHLF). This serious complication (with a 50% mortality rate) can be avoided by better assessment of liver volume and function of the future liver remnant (FLR). OBJECTIVE The aim of this review was to understand and assess clinical, biological, and imaging predictors of PHLF risk, as well as the various hypertrophy techniques, to achieve an adequate FLR before hepatectomy. METHOD We reviewed the state of the art in liver regeneration and FLR hypertrophy techniques. RESULTS The use of new biological scores (such as the aspartate aminotransferase/platelet ratio index + albumin-bilirubin [APRI+ALBI] score), concurrent utilization of 99mTc-mebrofenin scintigraphy (HBS), or dynamic hepatocyte contrast-enhanced MRI (DHCE-MRI) for liver volumetry helps predict the risk of PHLF. Besides portal vein embolization, there are other FLR optimization techniques that have their indications in case of risk of failure (e.g., associating liver partition and portal vein ligation for staged hepatectomy, liver venous deprivation) or in specific situations (transarterial radioembolization). CONCLUSION There is a need to standardize volumetry and function measurement techniques, as well as FLR hypertrophy techniques, to limit the risk of PHLF.
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Affiliation(s)
- Mehdi Boubaddi
- Hepatobiliary and Pancreatic Surgery Department, Bordeaux University Hospital Center, Bordeaux, France.
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Bordeaux University, Bordeaux, France.
| | - Arthur Marichez
- Hepatobiliary and Pancreatic Surgery Department, Bordeaux University Hospital Center, Bordeaux, France
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Bordeaux University, Bordeaux, France
| | - Jean-Philippe Adam
- Hepatobiliary and Pancreatic Surgery Department, Bordeaux University Hospital Center, Bordeaux, France
| | - Bruno Lapuyade
- Radiology Department, Bordeaux University Hospital Center, Bordeaux, France
| | - Frederic Debordeaux
- Nuclear Medicine Department, Bordeaux University Hospital Center, Bordeaux, France
| | - Ghoufrane Tlili
- Nuclear Medicine Department, Bordeaux University Hospital Center, Bordeaux, France
| | - Laurence Chiche
- Hepatobiliary and Pancreatic Surgery Department, Bordeaux University Hospital Center, Bordeaux, France
| | - Christophe Laurent
- Hepatobiliary and Pancreatic Surgery Department, Bordeaux University Hospital Center, Bordeaux, France
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Bordeaux University, Bordeaux, France
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Costa AC, Mazzotta A, Santa-Cruz F, Coelho FF, Tribillon E, Gayet B, Herman P, Soubrane O. Short-term outcomes of laparoscopic extended hepatectomy versus major hepatectomy: a single-center experience. HPB (Oxford) 2024; 26:818-825. [PMID: 38485564 DOI: 10.1016/j.hpb.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION Laparoscopic major hepatectomy (LMH) remains restricted to a few specialized centers and poses a challenge to surgeons performing laparoscopic resections. Laparoscopic extended resections are even more complex and rarely conducted. METHODS From a single-institution database, we compared the short-term outcomes of patients who underwent major and extended laparoscopic resections, stratifying the entire retrospective cohort into four groups: right hepatectomy, left hepatectomy, right extended hepatectomy, and left extended hepatectomy. Patient demographics, tumor characteristics, operative variables, and especially postoperative outcomes were evaluated. RESULTS 250 patients underwent major and extended laparoscopic liver resections, including 160 right, 31 right extended, 36 left, and 23 left extended laparoscopic hepatectomies. The most common indication for resection was colorectal liver metastases (64%). Laparoscopic extended hepatectomy (LEH) showed significantly longer operative time, more blood loss, need for Pringle maneuver, conversion to open surgery, higher rates of liver failure, postoperative ascites, and intra-abdominal hemorrhage, R1 margins and length of stay when compared with the LMH group. Mortality rates were similar between groups. Multivariate analysis revealed intraoperative blood transfusion (OR = 5.1[CI-95%: 1.15-6.79]; p = 0.02) as an independent predictor for major complications. CONCLUSIONS LEH showed to be feasible, however with higher blood loss and significantly associated to major complications.
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Affiliation(s)
- Adriano C Costa
- Department of Digestive, Metabolic and Oncologic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, Paris, France; Department of Gastroenterology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
| | - Alessandro Mazzotta
- Department of Digestive, Metabolic and Oncologic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, Paris, France
| | - Fernando Santa-Cruz
- Department of Gastroenterology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Fabricio F Coelho
- Department of Gastroenterology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Ecoline Tribillon
- Department of Digestive, Metabolic and Oncologic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, Paris, France
| | - Brice Gayet
- Department of Digestive, Metabolic and Oncologic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, Paris, France
| | - Paulo Herman
- Department of Gastroenterology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Olivier Soubrane
- Department of Digestive, Metabolic and Oncologic Surgery, Institut Mutualiste Montsouris, University René Descartes Paris 5, Paris, France
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You X, Zuo B, Jiang J, Cheng D, Li P, Xing H, Yang C, Zhang Y. Liver resection with two-step vascular exclusion, in situ hypothermic portal perfusion for the treatment of end-stage hepatic alveolar echinococcosis. Langenbecks Arch Surg 2024; 409:168. [PMID: 38819706 DOI: 10.1007/s00423-024-03351-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of two-step vascular exclusion and in situ hypothermic portal perfusion in patients with end-stage hepatic hydatidosis. METHODS This study involved patients with advanced hepatic hydatid disease undergoing surgical treatment between 2022 and 2023, which included resection and reconstruction of the hepatic veins, inferior vena cava (IVC), and portal vein (PV). We described the technical details of liver resection and vascular reconstruction, as well as the use of two-step vascular exclusion and in situ hypothermic portal perfusion techniques during the vascular reconstruction process. RESULT We included 7 patients with advanced hepatic hydatid disease who underwent surgical resection using two-step vascular exclusion and in situ hypothermic portal perfusion. The mean duration of surgery was 12.5 h (range, 7.5-15.0 h). The average hepatic ischemia time was 45 min (range, 25-77 min), while the occlusion time of the IVC was 87 min (range, 72-105 min). The total blood loss was 1000 milliliters (range, 500-1250 milliliters). Postoperatively, patients exhibited good recovery of liver and renal function. The mean ICU stay was 2 days (range, 1-3 days), and the mean postoperative hospital stay was 13 days (range, 9-16 days), with no Grade III or above complications observed during a mean follow-up period of 15 months (range, 9-24 months), CONCLUSION: two-step vascular exclusion and in situ hypothermic portal perfusion for surgical resection of end-stage hepatic hydatid disease is safe and effective. This significantly reduces the anhepatic time.
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Affiliation(s)
- Xinyu You
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- School of Medicine, Southwest Medical University, Luzhou, 646000, P. R. China
| | - Bangyou Zuo
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jipeng Jiang
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Donghui Cheng
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Peng Li
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongming Xing
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chong Yang
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
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Bozkurt E, Sijberden JP, Kasai M, Abu Hilal M. Efficacy and perioperative safety of different future liver remnant modulation techniques: a systematic review and network meta-analysis. HPB (Oxford) 2024; 26:465-475. [PMID: 38245490 DOI: 10.1016/j.hpb.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/20/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND In daily clinical practice, different future liver remnant (FLR) modulation techniques are increasingly used to allow a liver resection in patients with insufficient FLR volume. This systematic review and network meta-analysis aims to compare the efficacy and perioperative safety of portal vein ligation (PVL), portal vein embolization (PVE), liver venous deprivation (LVD) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). METHODS A literature search for studies comparing liver resections following different FLR modulation techniques was performed in MEDLINE, Embase and Cochrane Central, and pairwise and network meta-analyses were conducted. RESULTS Overall, 23 studies comprising 1557 patients were included. LVD achieved the greatest increase in FLR (17.32 %, 95% CI 2.49-32.15), while ALPPS was most effective in preventing dropout before the completion hepatectomy (OR 0.29, 95% CI 0.15-0.55). PVL tended to be associated with a longer time to completion hepatectomy (MD 5.78 days, 95% CI -0.67-12.23). Liver failure occurred less frequently after LVD, compared to PVE (OR 0.35, 95% CI 0.14-0.87) and ALPPS (OR 0.28, 95% CI 0.09-0.85). DISCUSSION ALPPS and LVD seem superior to PVE and PVL in terms of achieved FLR increase and subsequent treatment completion. LVD was associated with lower rates of post hepatectomy liver failure, compared to both PVE and ALPPS. A summary of the protocol has been prospectively registered in the PROSPERO database (CRD42022321474).
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Affiliation(s)
- Emre Bozkurt
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Department of Surgery, Hepatopancreatobiliary Surgery Division, Koç University Hospital, Istanbul, Turkey
| | - Jasper P Sijberden
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Amsterdam UMC Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Meidai Kasai
- Department of Surgery, Meiwa Hospital, Hyogo, Japan
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
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9
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Machairas N, Di Martino M, Primavesi F, Underwood P, de Santibanes M, Ntanasis-Stathopoulos I, Urban I, Tsilimigras DI, Siriwardena AK, Frampton AE, Pawlik TM. Simultaneous resection for colorectal cancer with synchronous liver metastases: current state-of-the-art. J Gastrointest Surg 2024; 28:577-586. [PMID: 38583912 DOI: 10.1016/j.gassur.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND A large proportion of patients with colorectal cancer (CRC) presents with synchronous colorectal liver metastases (sCRLM) at diagnosis. Surgical approaches for patients with sCRLM have evolved over the past decades. Simultaneous resection (SR) of CRC and sCRLM for selected patients has emerged as a safe and efficient alternative approach to traditional staged resections. METHODS A comprehensive review of the literature was performed using MEDLINE/PubMed and Web of Science databases with the end of search date October 30, 2023. The MeSH terms "simultaneous resections" and "combined resections" in combination with "colorectal liver metastases," "colorectal cancer," "liver resection," and "hepatectomy" were searched in the title and/or abstract. RESULTS SRs aim to achieve maximal tumor clearance, minimizing the risk of disease progression and optimizing the potential for long-term survival. Improvements in perioperative care, advances in surgical techniques, and a better understanding of patient selection criteria have collectively contributed to reducing morbidity and mortality associated with these complex procedures. Several studies have demonstrated that SR are associated with reduced overall length of stay and lower costs with comparable morbidity and long-term outcomes. In light of these outcomes, the proportion of patients undergoing SR for CRC and sCRLM has increased substantially over the past 2 decades. CONCLUSION For patients with sCRLM, SR represents an attractive alternative to the traditional staged approach and should be selectively used; however, the decision on whether to proceed with a simultaneous versus staged approach should be individualized based on several patient- and disease-related factors.
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Affiliation(s)
- Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Marcello Di Martino
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; Department of Surgery, University Maggiore Hospital della Carita, Novara, Italy
| | - Florian Primavesi
- Department of General, Visceral and Vascular Surgery, HPB Centre, Salzkammergutklinikum Hospital, Vöcklabruck, Austria
| | - Patrick Underwood
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, United States
| | - Martin de Santibanes
- Department of Surgery, Division of HPB Surgery, Liver and Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Iveta Urban
- Department of General, Visceral and Vascular Surgery, HPB Centre, Salzkammergutklinikum Hospital, Vöcklabruck, Austria
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, United States
| | - Ajith K Siriwardena
- Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Adam E Frampton
- HPB Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford, Surrey, United Kingdom; Section of Oncology, Surrey Cancer Research Institute, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, The Leggett Building, University of Surrey, Guildford, United Kingdom
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, Ohio, United States; Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, Ohio, United States.
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10
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Chandra P, Sacks GD. Contemporary Surgical Management of Colorectal Liver Metastases. Cancers (Basel) 2024; 16:941. [PMID: 38473303 DOI: 10.3390/cancers16050941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death. Approximately 20-30% of patients will develop hepatic metastasis in the form of synchronous or metachronous disease. The treatment of colorectal liver metastasis (CRLM) has evolved into a multidisciplinary approach, with chemotherapy and a variety of locoregional treatments, such as ablation and portal vein embolization, playing a crucial role. However, resection remains a core tenet of management, serving as the gold standard for a curative-intent therapy. As such, the input of a dedicated hepatobiliary surgeon is paramount for appropriate patient selection and choice of surgical approach, as significant advances in the field have made management decisions extremely nuanced and complex. We herein aim to review the contemporary surgical management of colorectal liver metastasis with respect to both perioperative and operative considerations.
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Affiliation(s)
- Pratik Chandra
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Greg D Sacks
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
- VA New York Harbor Healthcare System, New York, NY 10010, USA
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11
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Nevermann N, Bode J, Vischer M, Krenzien F, Lurje G, Pelzer U, Fehrenbach U, Auer TA, Schmelzle M, Pratschke J, Schöning W. Perioperative outcome and long-term survival for intrahepatic cholangiocarcinoma after portal vein embolization and subsequent resection: A propensity-matched study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107100. [PMID: 37918318 DOI: 10.1016/j.ejso.2023.107100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION In view of the high therapeutic value of surgical resection for intrahepatic cholangiocarcinomas (ICC), our study addresses the question of clinical management and outcome in case of borderline resectability requiring hypertrophy induction of the future liver remnant prior to resection. METHODS Clinical data was collected of all primary ICC cases receiving major liver resection with or without prior portal vein embolization (PVE) from a single high-volume center. PVE was performed via a percutaneous transhepatic access. Propensity score matching was performed. Perioperative morbidity was assessed as well as long-term survival with a minimum follow-up of 36 months. RESULTS No significant difference in perioperative morbidity was seen between the PVE and the control group. For the PVE group, median OS was 28 months vs. 37 months for the control group (p = 0.418), median DFS 18 and 14 months (p = 0.703). Disease progression during hypertrophy was observed in 38% of cases. Here, OS and DFS was reduced to 18 months (p = 0.479) and 6 months (p = 0.013), respectively. In case of positive N-status or multifocal tumor (MF+) OS was also reduced (18 vs. 26 months, p = 0.033; MF+: 9 vs. 36months p = 0.013). CONCLUSION Our results suggest that the surgical therapy in case of borderline resectability offers acceptable results with non-inferior OS rates compared to cases without preoperative hypertrophy induction and comparable oncological features. In the presence of additional risk factors (multifocal tumor, lymph node metastasis, PD during hypertrophy) the OS is notably reduced.
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Affiliation(s)
- N Nevermann
- Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | - J Bode
- Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | - M Vischer
- Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | - F Krenzien
- Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany; Clinical Scientist Program, Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - G Lurje
- Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | - U Pelzer
- Department of Hematology, Oncology and Tumorimmunology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - U Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T A Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Schmelzle
- Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | - J Pratschke
- Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | - W Schöning
- Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany.
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12
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Gerwing M, Schindler P, Katou S, Köhler M, Stamm AC, Schmidt VF, Heindel W, Struecker B, Morgul H, Pascher A, Wildgruber M, Masthoff M. Multi-organ Radiomics-Based Prediction of Future Remnant Liver Hypertrophy Following Portal Vein Embolization. Ann Surg Oncol 2023; 30:7976-7985. [PMID: 37670120 PMCID: PMC10625940 DOI: 10.1245/s10434-023-14241-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Portal vein embolization (PVE) is used to induce remnant liver hypertrophy prior to major hepatectomy. The purpose of this study was to evaluate the predictive value of baseline computed tomography (CT) data for future remnant liver (FRL) hypertrophy after PVE. METHODS In this retrospective study, all consecutive patients undergoing right-sided PVE with or without hepatic vein embolization between 2018 and 2021 were included. CT volumetry was performed before and after PVE to assess standardized FRL volume (sFRLV). Radiomic features were extracted from baseline CT after segmenting liver (without tumor), spleen and bone marrow. For selecting features that allow classification of response (hypertrophy ≥ 1.33), a stepwise dimension reduction was performed. Logistic regression models were fitted and selected features were tested for their predictive value. Decision curve analysis was performed on the test dataset. RESULTS A total of 53 patients with liver tumor were included in this study. sFRLV increased significantly after PVE, with a mean hypertrophy of FRL of 1.5 ± 0.3-fold. sFRLV hypertrophy ≥ 1.33 was reached in 35 (66%) patients. Three independent radiomic features, i.e. liver-, spleen- and bone marrow-associated, differentiated well between responders and non-responders. A logistic regression model revealed the highest accuracy (area under the curve 0.875) for the prediction of response, with sensitivity of 1.0 and specificity of 0.5. Decision curve analysis revealed a positive net benefit when applying the model. CONCLUSIONS This proof-of-concept study provides first evidence of a potential predictive value of baseline multi-organ radiomics CT data for FRL hypertrophy after PVE.
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Affiliation(s)
- Mirjam Gerwing
- Clinic for Radiology, University Hospital Münster, Münster, Germany.
| | | | - Shadi Katou
- Department for General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Michael Köhler
- Clinic for Radiology, University Hospital Münster, Münster, Germany
| | | | | | - Walter Heindel
- Clinic for Radiology, University Hospital Münster, Münster, Germany
| | - Benjamin Struecker
- Department for General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Haluk Morgul
- Department for General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Andreas Pascher
- Department for General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Moritz Wildgruber
- Clinic for Radiology, University Hospital Münster, Münster, Germany
- Department for Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Masthoff
- Clinic for Radiology, University Hospital Münster, Münster, Germany
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13
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Ratti F, Marino R, Muiesan P, Zieniewicz K, Van Gulik T, Guglielmi A, Marques HP, Andres V, Schnitzbauer A, Irinel P, Schmelzle M, Sparrelid E, Fusai GK, Adam R, Cillo U, Lang H, Oldhafer K, Ruslan A, Ciria R, Ferrero A, Mazzaferro V, Cescon M, Giuliante F, Nadalin S, Golse N, Sulpice L, Serrablo A, Ramos E, Marchese U, Rosok B, Lopez-Lopez V, Clavien P, Aldrighetti L. Results from the european survey on preoperative management and optimization protocols for PeriHilar cholangiocarcinoma. HPB (Oxford) 2023; 25:1302-1322. [PMID: 37543473 DOI: 10.1016/j.hpb.2023.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/24/2023] [Accepted: 06/21/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Major surgery, along with preoperative cholestasis-related complications, are responsible for the increased risk of morbidity and mortality in perihilar cholangiocarcinoma (pCCA). The aim of the present survey is to provide a snapshot of current preoperative management and optimization strategies in Europe. METHODS 61 European centers, experienced in hepato-biliary surgery completed a 59-questions survey regarding pCCA preoperative management. Centers were stratified according to surgical caseload (<5 and ≥ 5 cases/year) and preoperative management protocols' application. RESULTS The overall case volume consisted of 6333 patients. Multidisciplinary discussion was routinely performed in 91.8% of centers. Most respondents (96.7%) recognized the importance of a well-structured preoperative protocol. The preferred method for biliary drainage was percutaneous transhepatic biliary drainage (60.7%) while portal vein embolization was the preferred technique for liver hypertrophy (90.2%). Differences in preoperative pathologic confirmation of malignancy (35.8% vs 28.7%; p < 0.001), number of mismanaged referred patients (88.2% vs 50.8%; p < 0.001), biliary drainage (65.1% vs 55.6%; p = 0.015) and liver function evaluation (37.2% vs 5.6%; p = 0.001) were found between centers according to groups' stratification. CONCLUSION The importance of a correct preoperative management is recognized. Nevertheless, the current lack of guidelines leads to wide heterogeneity of behaviors among centers. This survey can provide recommendations to improve pCCA perioperative outcomes.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy.
| | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
| | | | - Krzysztof Zieniewicz
- Dept of General, Transplant and Liver Surgery, Medical University, Warsaw, Poland
| | - Tomas Van Gulik
- Academic Medical Center, Erasmus Medica Center, Amsterdam, the Netherlands
| | - Alfredo Guglielmi
- General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | | | | | | | - Popescu Irinel
- Center of General Surgery and Liver Transplant, Fundeni Clinical Institut, Bucharest, Romania
| | | | | | | | - Renè Adam
- Paul Brousse University Hospital, Paris, France; Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Padova, Italy
| | - Hauke Lang
- University Medical Center Mainz, Mainz, Germany
| | | | | | - Ruben Ciria
- University Hospital Reina Sofia, Cordoba, Spain
| | | | - Vincenzo Mazzaferro
- University of Milan, Department of Oncology and Hemato-Oncology, Istituto Nazionale Tumori, Milan, Italy
| | | | | | | | | | | | | | - Emilio Ramos
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | | | | | | | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
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14
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Du S, Wang Z, Lin D. A bibliometric and visualized analysis of preoperative future liver remnant augmentation techniques from 1997 to 2022. Front Oncol 2023; 13:1185885. [PMID: 37333827 PMCID: PMC10272555 DOI: 10.3389/fonc.2023.1185885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Background The size and function of the future liver remnant (FLR) is an essential consideration for both eligibility for treatment and postoperative prognosis when planning surgical hepatectomy. Over time, a variety of preoperative FLR augmentation techniques have been investigated, from the earliest portal vein embolization (PVE) to the more recent Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) procedures. Despite numerous publications on this topic, no bibliometric analysis has yet been conducted. Methods Web of Science Core Collection (WoSCC) database was searched to identify studies related to preoperative FLR augmentation techniques published from 1997 to 2022. The analysis was performed using the CiteSpace [version 6.1.R6 (64-bit)] and VOSviewer [version 1.6.19]. Results A total of 973 academic studies were published by 4431 authors from 920 institutions in 51 countries/regions. The University of Zurich was the most published institution while Japan was the most productive country. Eduardo de Santibanes had the most published articles, and Masato Nagino was the most frequently co-cited author. The most frequently published journal was HPB, and the most cited journal was Ann Surg, with 8088 citations. The main aspects of preoperative FLR augmentation technique is to enhance surgical technology, expand clinical indications, prevent and treat postoperative complications, ensure long-term survival, and evaluate the growth rate of FLR. Recently, hot keywords in this field include ALPPS, LVD, and Hepatobiliary Scintigraphy. Conclusion This bibliometric analysis provides a comprehensive overview of preoperative FLR augmentation techniques, offering valuable insights and ideas for scholars in this field.
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Calderon Novoa F, Ardiles V, de Santibañes E, Pekolj J, Goransky J, Mazza O, Sánchez Claria R, de Santibañes M. Pushing the Limits of Surgical Resection in Colorectal Liver Metastasis: How Far Can We Go? Cancers (Basel) 2023; 15:cancers15072113. [PMID: 37046774 PMCID: PMC10093442 DOI: 10.3390/cancers15072113] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Colorectal cancer is the third most common cancer worldwide, and up to 50% of all patients diagnosed will develop metastatic disease. Management of colorectal liver metastases (CRLM) has been constantly improving, aided by newer and more effective chemotherapy agents and the use of multidisciplinary teams. However, the only curative treatment remains surgical resection of the CRLM. Although survival for surgically resected patients has shown modest improvement, this is mostly because of the fact that what is constantly evolving is the indication for resection. Surgeons are constantly pushing the limits of what is considered resectable or not, thus enhancing and enlarging the pool of patients who can be potentially benefited and even cured with aggressive surgical procedures. There are a variety of procedures that have been developed, which range from procedures to stimulate hepatic growth, such as portal vein embolization, two-staged hepatectomy, or the association of both, to technically challenging procedures such as simultaneous approaches for synchronous metastasis, ex-vivo or in-situ perfusion with total vascular exclusion, or even liver transplant. This article reviewed the major breakthroughs in liver surgery for CRLM, showing how much has changed and what has been achieved in the field of CRLM.
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Affiliation(s)
- Francisco Calderon Novoa
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Victoria Ardiles
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Eduardo de Santibañes
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Juan Pekolj
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Jeremias Goransky
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Oscar Mazza
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Rodrigo Sánchez Claria
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Martín de Santibañes
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
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Rajakannu M, Cherqui D, Cunha AS, Castaing D, Adam R, Vibert E. Predictive nomograms for postoperative 90-day morbidity and mortality in patients undergoing liver resection for various hepatobiliary diseases. Surgery 2023; 173:993-1000. [PMID: 36669938 DOI: 10.1016/j.surg.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Postoperative complications affect the long-term survival and quality of life in patients undergoing liver resection. No model has yet been validated to predict 90-day severe morbidity and mortality. METHODS The prospective recruitment of patients undergoing liver resection for various indications was performed. Preoperative clinical and laboratory data, including liver stiffness, indocyanine green retention, and intraoperative parameters, were analyzed to develop predictive nomograms for postoperative severe morbidity and mortality. Calibration plots were used to perform external validation. RESULTS The most common indications in 418 liver resections performed were colorectal metastases (N = 149 [35.6%]), hepatocellular carcinoma (N = 106 [25.4%]), and benign liver tumors (N = 60 [14.3%]). Major liver resections were performed in 164 (39.2%) patients. Severe morbidity and mortality were observed in 87 (20.8%) and 9 (2.2%) of patients, respectively, during the 90-day postoperative period. Post-hepatectomy liver failure was observed in 19 (4.5%) patients, resulting in the death of 4. The independent predictors of 90-day severe morbidity were age (odds ratio:1.02, P = .06), liver stiffness (odds ratio: 1.23, P = .04], number of resected segments (odds ratio: 1.28, P = .004), and operative time (odds ratio: 1.01, P = .01). Independent predictors of 90-day mortality were diabetes mellitus (odds ratio: 6.6, P = .04), tumor size >50 mm (odds ratio:4.8, P = .08), liver stiffness ≥22 kPa (odds ratio:7.0, P = .04), and operative time ≥6 hours (odds ratio: 6.1, P = .05). Nomograms were developed using these independent predictors and validated by testing the Goodness of fit in calibration plots (P = .64 for severe morbidity; P = .8 for mortality). CONCLUSION Proposed nomograms would enable a personalized approach to identifying patients at risk of complications and adapting surgical treatment according to their clinical profile and the center's expertise.
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Affiliation(s)
- Muthukumarassamy Rajakannu
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Denis Castaing
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - René Adam
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Inserm, Unité UMR-S 776, Villejuif, France
| | - Eric Vibert
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France. https://twitter.com/Eric_Vibert
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Kupietzky A, Ariche A. Surgical Aspects of Intrahepatic Cholangiocarcinoma. Cancers (Basel) 2022; 14:cancers14246265. [PMID: 36551749 PMCID: PMC9777062 DOI: 10.3390/cancers14246265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is a rare and aggressive malignancy. It originates from the bile ducts and is the second most common primary cancer of the liver. Surgery is considered the only curative treatment of ICC, offering the best chance for long-term survival. The purpose of this article is to review the available literature on ICC, with a focus on the various aspects of the surgical care in this potentially lethal malignancy.
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Sparrelid E, Olthof PB, Dasari BVM, Erdmann JI, Santol J, Starlinger P, Gilg S. Current evidence on posthepatectomy liver failure: comprehensive review. BJS Open 2022; 6:6840812. [PMID: 36415029 PMCID: PMC9681670 DOI: 10.1093/bjsopen/zrac142] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite important advances in many areas of hepatobiliary surgical practice during the past decades, posthepatectomy liver failure (PHLF) still represents an important clinical challenge for the hepatobiliary surgeon. The aim of this review is to present the current body of evidence regarding different aspects of PHLF. METHODS A literature review was conducted to identify relevant articles for each topic of PHLF covered in this review. The literature search was performed using Medical Subject Heading terms on PubMed for articles on PHLF in English until May 2022. RESULTS Uniform reporting on PHLF is lacking due to the use of various definitions in the literature. There is no consensus on optimal preoperative assessment before major hepatectomy to avoid PHLF, although many try to estimate future liver remnant function. Once PHLF occurs, there is still no effective treatment, except liver transplantation, where the reported experience is limited. DISCUSSION Strict adherence to one definition is advised when reporting data on PHLF. The use of the International Study Group of Liver Surgery criteria of PHLF is recommended. There is still no widespread established method for future liver remnant function assessment. Liver transplantation is currently the only effective way to treat severe, intractable PHLF, but for many indications, this treatment is not available in most countries.
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Affiliation(s)
- Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pim B Olthof
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bobby V M Dasari
- Department of HPB Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK.,University of Birmingham, Birmingham, UK
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jonas Santol
- Department of Surgery, HPB Center, Viennese Health Network, Clinic Favoriten and Sigmund Freud Private University, Vienna, Austria.,Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Patrick Starlinger
- Division of General Surgery, Department of Surgery, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria.,Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, New York, USA
| | - Stefan Gilg
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Vaz da Silva DG, Bredt LC, Diniz AL, Vieira VHR, Fernandes PHS, Ribeiro R, Ribeiro HC, Oliveira AF. Brazilian Society of Surgical Oncology surgical standards for resectable colorectal cancer liver metastases. J Surg Oncol 2022; 126:28-36. [PMID: 35689577 DOI: 10.1002/jso.26879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Diego G. Vaz da Silva
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgical Oncology Mário Covas State Hospital, Centro Universitário Faculdade de Medicina do ABC Santo André São Paulo Brazil
| | - Luis C. Bredt
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgical Oncology Universidade Estadual do Oeste do Paraná Cascavel Paraná Brazil
| | - Alessandro L. Diniz
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Upper GI and HPB Surgical Oncology AC Camargo Cancer Center São Paulo São Paulo Brazil
| | - Victor H. R. Vieira
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgical Oncology Rede D'Or São Luiz, Hospital Federal de Bonsucesso Rio de Janeiro Rio de Janeiro Brazil
| | - Paulo H. S. Fernandes
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgical Oncology Universidade Federal de Uberlândia Uberlândia Minas Gerais Brazil
| | - Reitan Ribeiro
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgical Oncology Erasto Gaertner Hospital Curitiba Paraná Brazil
| | - Héber S. C. Ribeiro
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Upper GI and HPB Surgical Oncology AC Camargo Cancer Center São Paulo São Paulo Brazil
| | - Alexandre F. Oliveira
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgery Universidade Federal de Juiz de Fora Juiz de Fora Minas Gerais Brazil
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He C, Ge N, Wang X, Li H, Chen S, Yang Y. Conversion Therapy of Large Unresectable Hepatocellular Carcinoma With Ipsilateral Portal Vein Tumor Thrombus Using Portal Vein Embolization Plus Transcatheter Arterial Chemoembolization. Front Oncol 2022; 12:923566. [PMID: 35814420 PMCID: PMC9261438 DOI: 10.3389/fonc.2022.923566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/18/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundThe study aimed to assess the safety and efficacy of conversion therapy with portal vein embolization (PVE) and transcatheter arterial chemoembolization (TACE) in patients with large unresectable hepatocellular carcinoma (HCC) and ipsilateral portal vein tumor thrombus (PVTT).MethodsThis retrospective study evaluated consecutive patients with initially large (≥5 cm) unresectable HCC with ipsilateral PVTT who underwent PVE + TACE at our center between June 2016 and September 2020 (Group A). Clinically equivalent patients from three centers who were receiving tyrosine kinase inhibitors (TKIs) + TACE (Group B) were included. The survival times were evaluated and compared between the two therapeutic groups.ResultsIn Group A (n = 33), the median tumor diameter was 14 cm (range, 5–18 cm) and 19 (57.6%) patients underwent radical resection 18–95 days after PVE. Radical liver resection was not performed because of inadequate hypertrophy (n = 11), pulmonary metastasis (n = 1), lack of consent for surgery (n = 1), and the rupture of the HCC (n = 1). There were no patients who underwent radical resection in Group B (n = 64) (P = 0.000). The mean and median overall survival (OS) were 736.5 days and 425.0 days in Group A and 424.5 days and 344.0 days in Group B, respectively. Compared with TKIs + TACE, treatment with PVE + TACE prolonged OS (P = 0.023).ConclusionsThis study shows that conversion therapy was safe and effective in patients with initially large unresectable HCC with ipsilateral PVTT treated with PVE + TACE. Moreover, PVE + TACE conferred more favorable outcomes than treatment with TKIs + TACE.
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Affiliation(s)
- Chengjian He
- Mini-Invasive Intervention Center, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University/Navy Medical University, Shanghai, China
| | - Naijian Ge
- Mini-Invasive Intervention Center, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University/Navy Medical University, Shanghai, China
| | - Xiangdong Wang
- Mini-Invasive Intervention Center, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University/Navy Medical University, Shanghai, China
| | - Hai Li
- Mini-Invasive Intervention Center, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University/Navy Medical University, Shanghai, China
| | - Shiguang Chen
- Department of Interventional Oncology, Fujian Medical University Cancer Hospital, Fuzhou, China
- *Correspondence: Yefa Yang, ; Shiguang Chen,
| | - Yefa Yang
- Mini-Invasive Intervention Center, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University/Navy Medical University, Shanghai, China
- *Correspondence: Yefa Yang, ; Shiguang Chen,
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21
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He C, Ge N, Yang Y. Feasibility and Safety of Delayed Catheter Removal Technique in Percutaneous Trans-Hepatic Portal Vein Embolization. Technol Cancer Res Treat 2022; 21:15330338221075154. [PMID: 35119340 PMCID: PMC8819806 DOI: 10.1177/15330338221075154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: This retrospective study aimed to evaluate the technical feasibility and safety of the delayed catheter removal technique in trans-hepatic portal vein embolization (PVE) and to explore a suitable technique. Methods: This was a retrospective study. In 278 consecutive patients, the puncture tract of the trans-hepatic PVE was treated using the delayed catheter removal technique after PVE. The existence of peripheral hepatic hematoma formation was assessed using ultrasound (US). Follow-up examinations such as magnetic resonance imaging (MRI), computed tomography (CT), and/or US were performed to evaluate perihepatic hematoma formation, hemoperitoneum, and other major complications. Results: Instant hemostasis was achieved in all patients after the procedure. PVE-associated complications were observed in 9 patients (3.24%). No perihepatic hematoma or hemoperitoneum was found in any of the patients. Conclusion: With the appropriate technique, the delayed catheter removal technique can be reliably utilized as a substitute for hemostasis as it is simple and free. This technique should be further evaluated and compared with other methods. Advances in knowledge: This study is the first to investigate the safety and feasibility of the delayed catheter removal technique for embolizing the puncture tract of the trans-hepatic PVE.
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Affiliation(s)
- Chengjian He
- Mini-Invasive Intervention Center, 535219Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Naijian Ge
- Mini-Invasive Intervention Center, 535219Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
| | - Yefa Yang
- Mini-Invasive Intervention Center, 535219Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
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Krenzien F, Nevermann N, Krombholz A, Benzing C, Haber P, Fehrenbach U, Lurje G, Pelzer U, Pratschke J, Schmelzle M, Schöning W. Treatment of Intrahepatic Cholangiocarcinoma-A Multidisciplinary Approach. Cancers (Basel) 2022; 14:cancers14020362. [PMID: 35053523 PMCID: PMC8773654 DOI: 10.3390/cancers14020362] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary This review discusses multimodality treatment strategies for intrahepatic cholangiocarcinoma (iCC). Surgical resection remains the only potentially curative therapeutic option and the central cornerstone of treatment. Adjuvant systemic treatment will be recommended after resection or in the palliative setting. Increasing knowledge of phenotypic subclassification and molecular profiling allows investigation of targeted therapies as (neo-)adjuvant treatment. High-dose brachytherapy, internal radiation therapy, and transarterial chemoembolization are among the interventional treatment options being evaluated for unresectable iCC. Given the multiple options of multidisciplinary management, any treatment strategy should be discussed in a multidisciplinary tumor board and treatment should be directed by a specialized treatment center. Abstract Intrahepatic cholangiocarcinoma (iCC) is distinguished as an entity from perihilar and distal cholangiocarcinoma and gallbladder carcinoma. Recently, molecular profiling and histopathological features have allowed further classification. Due to the frequent delay in diagnosis, the prognosis for iCC remains poor despite major technical advances and multimodal therapeutic approaches. Liver resection represents the therapeutic backbone and only curative treatment option, with the functional residual capacity of the liver and oncologic radicality being deciding factors for postoperative and long-term oncological outcome. Furthermore, in selected cases and depending on national guidelines, liver transplantation may be a therapeutic option. Given the often advanced tumor stage at diagnosis or the potential for postoperative recurrence, locoregional therapies have become increasingly important. These strategies range from radiofrequency ablation to transarterial chemoembolization to selective internal radiation therapy and can be used in combination with liver resection. In addition, adjuvant and neoadjuvant chemotherapies as well as targeted therapies and immunotherapies based on molecular profiles can be applied. This review discusses multimodal treatment strategies for iCC and their differential use.
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Affiliation(s)
- Felix Krenzien
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
- Berlin Institute of Health (BIH), 13353 Berlin, Germany
| | - Nora Nevermann
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
- Correspondence:
| | - Alina Krombholz
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Christian Benzing
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Philipp Haber
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Uli Fehrenbach
- Clinic for Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Georg Lurje
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Uwe Pelzer
- Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
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Mojtahed A, Núñez L, Connell J, Fichera A, Nicholls R, Barone A, Marieiro M, Puddu A, Arya Z, Ferreira C, Ridgway G, Kelly M, Lamb HJ, Caseiro-Alves F, Brady JM, Banerjee R. Repeatability and reproducibility of deep-learning-based liver volume and Couinaud segment volume measurement tool. Abdom Radiol (NY) 2022; 47:143-151. [PMID: 34605963 PMCID: PMC8776724 DOI: 10.1007/s00261-021-03262-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 12/27/2022]
Abstract
Purpose Volumetric and health assessment of the liver is crucial to avoid poor post-operative outcomes following liver resection surgery. No current methods allow for concurrent and accurate measurement of both Couinaud segmental volumes for future liver remnant estimation and liver health using non-invasive imaging. In this study, we demonstrate the accuracy and precision of segmental volume measurements using new medical software, Hepatica™. Methods MRI scans from 48 volunteers from three previous studies were used in this analysis. Measurements obtained from Hepatica™ were compared with OsiriX. Time required per case with each software was also compared. The performance of technicians and experienced radiologists as well as the repeatability and reproducibility were compared using Bland–Altman plots and limits of agreement. Results High levels of agreement and lower inter-operator variability for liver volume measurements were shown between Hepatica™ and existing methods for liver volumetry (mean Dice score 0.947 ± 0.010). A high consistency between technicians and experienced radiologists using the device for volumetry was shown (± 3.5% of total liver volume) as well as low inter-observer and intra-observer variability. Tight limits of agreement were shown between repeated Couinaud segment volume (+ 3.4% of whole liver), segmental liver fibroinflammation and segmental liver fat measurements in the same participant on the same scanner and between different scanners. An underestimation of whole-liver volume was observed between three non-reference scanners. Conclusion Hepatica™ produces accurate and precise whole-liver and Couinaud segment volume and liver tissue characteristic measurements. Measurements are consistent between trained technicians and experienced radiologists. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00261-021-03262-x.
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Affiliation(s)
- Amirkasra Mojtahed
- Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Luis Núñez
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - John Connell
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK.
| | | | - Rowan Nicholls
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Angela Barone
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Mariana Marieiro
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Anthony Puddu
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Zobair Arya
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Carlos Ferreira
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Ged Ridgway
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Matt Kelly
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - J Michael Brady
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
| | - Rajarshi Banerjee
- Perspectum Ltd., Gemini One, 5520 John Smith Drive, Oxford, OX4 2LL, UK
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Systematic Reviews and Meta-Analyses of Portal Vein Embolization, Associated Liver Partition and Portal Vein Ligation, and Radiation Lobectomy Outcomes in Hepatocellular Carcinoma Patients. Curr Oncol Rep 2021; 23:135. [PMID: 34716800 DOI: 10.1007/s11912-021-01075-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To understand portal vein embolization (PVE), associated liver partition and portal vein ligation (ALPPS) and radiation lobectomy (RL) outcomes in hepatocellular carcinoma (HCC) patients. Systematic reviews of future liver remnant (FLR) percent hypertrophy, proportion undergoing hepatectomy and proportion with major complications following PVE, ALPPS, and RL were performed by searching Ovid MEDLINE, Ovid EMBASE, The Cochrane Library, and Web of Science. Separate meta-analyses using random-effects models with assessment of study heterogeneity and publication bias were performed whenever allowable by available data. RECENT FINDINGS Of the 10,616 articles screened, 21 articles with 636 subjects, 4 articles with 65 subjects, and 4 articles with 195 subjects met the inclusion criteria for systematic reviews and meta-analyses for PVE, ALPPS, and RL, respectively. The pooled estimate of mean percent FLR hypertrophy was 30.9% (95%CI: 22-39%, Q = 4034.8, p < 0.0001) over 40.3 +/- 26.3 days for PVE, 54.9% (95%CI: 36-74%, Q = 73.8, p < 0.0001) over 11.1 +/- 3.1 days for ALPPS, and 29.0% (95%CI: 23-35%, Q = 56.2, p < 0.0001) over 138.5 +/- 56.5 days for RL. The pooled proportion undergoing hepatectomy was 91% (95%CI: 83-95%, Q = 43.9, p = 0.002) following PVE and 98% (95%CI: 50-100%, Q = 0.0, p = 1.0) following ALPPS. The pooled proportion with major complications was 5% (95%CI: 2-10%, Q = 7.3, p = 0.887) following PVE and 38% (95%CI: 18-63%, Q = 10.0, p = 0.019) following ALPPS. Though liver hypertrophy occurs following all three treatments in HCC patients, PVE balances effective hypertrophy with a short time frame and low major complication rate.
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Heller M, Parikh ND, Fidelman N, Owen D. Frontiers of therapy for hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46:3648-3659. [PMID: 33837453 DOI: 10.1007/s00261-021-03065-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Abstract
The incidence of hepatocellular carcinoma continues to increase worldwide. Fortunately, there have been notable recent advances in locoregional and systemic therapy. In this current review, we will highlight these new developments and future directions of hepatocellular carcinoma treatment and address the importance of a multidisciplinary approach to treatment.
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Brüning R, Schneider M, Tiede M, Wohlmuth P, Stavrou G, von Hahn T, Ehrenfeld A, Reese T, Makridis G, Stang A, Oldhafer KJ. Ipsilateral access portal venous embolization (PVE) for preoperative hypertrophy exhibits low complication rates in Clavien-Dindo and CIRSE scales. CVIR Endovasc 2021; 4:41. [PMID: 33999299 PMCID: PMC8128945 DOI: 10.1186/s42155-021-00227-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Portal venous embolization (PVE) is a minimal invasive preoperative strategy that aims to increase future liver remnant (FLR) in order to facilitate extended hemihepatectomy. We analyzed our data retrospectively regarding complications and degree of hypertrophy (DH). Methods: 88 patients received PVE either by particles / coils (n = 77) or by glue / oil (n = 11), supported by 7 right hepatic vein embolizations (HVE) by coils or occluders. All complications were categorized by the Clavien- Dindo (CD) and the CIRSE classification. Results In 88 patients (median age 68 years) there was one intervention with a biliary leak and subsequent drainage (complication grade 3 CD, CIRSE 3), two with prolonged hospital stay (grade 2 CD, grade 3 CIRSE) and 13 complications grade 1 CD, but no complications of grade 4 or higher neither in Clavien- Dindo nor in CIRSE classification. The median relative increase in FLR was 47% (SD 35%). The mean pre-intervention standardized FLR rose from 23% (SD 10%) to a post-intervention standardized FLR of 32% (SD 12%). The degree of hypertrophy (DH) was 9,3% (SD 5,2%) and the kinetic growth rate (KGR) per week was 2,06 (SD 1,84). Conclusion PVE and, if necessary, additional sequential HVE were safe procedures with a low rate of complications and facilitated sufficient preoperative hypertrophy of the future liver remnant.
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Affiliation(s)
- Roland Brüning
- Radiology and Neuroradiology, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany. .,Faculty of medicine, Bavariaring 19, 80336, München, Germany.
| | - Martin Schneider
- Radiology and Neuroradiology, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Michel Tiede
- Radiology and Neuroradiology, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Peter Wohlmuth
- Biostatistics, ProResearch, Lohmuehlenstrasse 5, 20099, Hamburg, Germany
| | - Gregor Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbruecken, Winterberg 1, 66199, Saarbrücken, Germany
| | - Thomas von Hahn
- Gastroenterology, Hepatology and interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany.,Medical Faculty, Semmelweis University Budapest, Üllői út 26, 1085, Budapest, Hungary
| | - Andrea Ehrenfeld
- Gastroenterology, Hepatology and interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Tim Reese
- Medical Faculty, Semmelweis University Budapest, Üllői út 26, 1085, Budapest, Hungary.,Department of Surgery, Division of Liver-, Bileduct- and Pancreatic Surgery, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Georgios Makridis
- Department of Surgery, Division of Liver-, Bileduct- and Pancreatic Surgery, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Axel Stang
- Medical Faculty, Semmelweis University Budapest, Üllői út 26, 1085, Budapest, Hungary.,Oncology, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
| | - Karl J Oldhafer
- Medical Faculty, Semmelweis University Budapest, Üllői út 26, 1085, Budapest, Hungary.,Department of Surgery, Division of Liver-, Bileduct- and Pancreatic Surgery, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany
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Elshaarawy O, Aman A, Zakaria HM, Zakareya T, Gomaa A, Elshimi E, Abdelsameea E. Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis. World J Gastrointest Oncol 2021; 13:424-439. [PMID: 34040703 PMCID: PMC8131904 DOI: 10.4251/wjgo.v13.i5.424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/11/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Given the poor synthetic function of cirrhotic liver, successful resection for patients with hepatocellular carcinoma (HCC) necessitates the ability to achieve resections with tumor free margins. AIM To validate post hepatectomy liver failure score (PHLF), compare it to other established systems and to stratify risks in patients with cirrhosis who underwent curative liver resection for HCC. METHODS Between December 2010 and January 2017, 120 patients underwent curative resection for HCC in patients with cirrhosis were included, the pre-operative, operative and post-operative factors were recorded to stratify patients' risks of decompensation, survival, and PHLF. RESULTS The preoperative model for end-stage liver disease (MELD) score [odds ratio (OR) = 2.7, 95%CI: 1.2-5.7, P = 0.013], tumor diameter (OR = 5.4, 95%CI: 2-14.8, P = 0.001) and duration of hospital stay (OR = 2.5, 95%CI: 1.5-4.2, P = 0.001) were significant independent predictors of hepatic decompensation after resection. While the preoperative MELD score [hazard ratio (HR) = 1.37, 95%CI: 1.16-1.62, P < 0.001] and different grades of PHLF (grade A: HR = 2.33, 95%CI: 0.59-9.24; Grade B: HR = 3.15, 95%CI: 1.11-8.95; Grade C: HR = 373.41, 95%CI: 66.23-2105.43; P < 0.001) and HCC recurrence (HR = 11.67, 95%CI: 4.19-32.52, P < 0.001) were significant independent predictors for survival. CONCLUSION Preoperative MELD score and tumor diameter can independently predict hepatic decompensation. While, preoperative MELD score, different grades of PHLF and HCC recurrence can precisely predict survival.
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Affiliation(s)
- Omar Elshaarawy
- Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Menoufia, Egypt
| | - Aya Aman
- Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Menoufia, Egypt
| | - Hazem Mohamed Zakaria
- Department of Hepatobiliary Pancreatic Surgery, National Liver Institute, Menoufia University, Shebine Elkom 32511, Menoufia, Egypt
| | - Talaat Zakareya
- Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Menoufia, Egypt
| | - Asmaa Gomaa
- Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Menoufia, Egypt
| | - Esam Elshimi
- Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Menoufia, Egypt
| | - Eman Abdelsameea
- Department of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Shebine Elkom 32511, Menoufia, Egypt
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Beppu T, Yamamura K, Okabe H, Imai K, Hayashi H. Oncological benefits of portal vein embolization for patients with hepatocellular carcinoma. Ann Gastroenterol Surg 2021; 5:287-295. [PMID: 34095718 PMCID: PMC8164464 DOI: 10.1002/ags3.12414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 12/28/2022] Open
Abstract
Portal vein embolization (PVE) for hepatocellular carcinoma (HCC) was first introduced in 1986 and has been continuously developed throughout the years. Basically, PVE has been applied to expand the indication of liver resection for HCC patients of insufficient future liver remnant. Importantly, PVE can result in tumor progression in both embolized and non-embolized livers; however, long-term survival after liver resection following PVE is at least not inferior compared with liver resection alone despite the smaller future liver remnant volume. Five-year disease-free survival and 5-year overall survival were 17% to 49% and 12% to 53% in non-PVE patients, and 21% to 78% and 44% to 72% in PVE patients, respectively. At present, it has proven that PVE has multiple oncological advantages for both surgical and nonsurgical treatments. PVE can also enhance the anticancer effects of transarterial chemoembolization and can avoid intraportal tumor cell dissemination. Additional interventional transarterial chemoembolization and hepatic vein embolization as well as surgical two-stage hepatectomy and associated liver partition and portal vein ligation for staged hepatectomy can enhance the oncological benefit of PVE monotherapy. Taken together, PVE is an important treatment which we recommend for listing in the guidelines for HCC treatment strategies.
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Affiliation(s)
- Toru Beppu
- Department of SurgeryYamaga City Medical CenterKumamotoJapan
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
| | - Kensuke Yamamura
- Department of SurgeryYamaga City Medical CenterKumamotoJapan
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
| | - Hirohisa Okabe
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
| | - Katsunori Imai
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
| | - Hiromitsu Hayashi
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
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Luz JHM, Veloso Gomes F, Costa NV, Vasco I, Coimbra E, Luz PM, Marques HP, Coelho JS, Mega RMA, Ribeiro VNTV, da Costa Lamelas JTR, de Sampaio Nunes E Sobral MM, da Silva SRG, de Teixeira Carrelha AS, Rodrigues SCC, de Figueiredo AAFP, Santos MV, Bilhim T. BestFLR Trial: Liver Regeneration at CT before Major Hepatectomies for Liver Cancer-A Randomized Controlled Trial Comparing Portal Vein Embolization with N-Butyl-Cyanoacrylate Plus Iodized Oil versus Polyvinyl Alcohol Particles Plus Coils. Radiology 2021; 299:715-724. [PMID: 33825512 DOI: 10.1148/radiol.2021204055] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background In patients with liver cancer, portal vein embolization (PVE) is recommended to promote liver growth before major hepatectomies. However, the optimal embolization strategy has not been established. Purpose To compare liver regeneration as seen at CT in participants with liver cancer, before major hepatectomies, with N-butyl-cyanoacrylate (NBCA) plus iodized oil versus standard polyvinyl alcohol (PVA) particles plus coils, for PVE. Materials and Methods In this single-center, prospective, randomized controlled trial (Best Future Liver Remnant, or BestFLR, trial; International Standard Randomized Controlled Trial Number 16062796), PVE with NBCA plus iodized oil was compared with standard PVE with PVA particles plus coils in participants with liver cancer. Participant recruitment started in November 2017 and ended in March 2020. Participants were randomly assigned to undergo PVE with PVA particles plus coils or PVE with NBCA plus iodized oil. The primary end point was liver growth assessed with CT 14 days and 28 days after PVE. Secondary outcomes included posthepatectomy liver failure, surgical complications, and length of intensive care treatment and hospital stay. The Mann-Whitney U test was used to compare continuous outcomes according to PVE material, whereas the Χ2 test or Fisher exact test was used for categoric variables. Results Sixty participants (mean age, 61 years ± 11 [standard deviation]; 32 men) were assigned to the PVA particles plus coils group (n = 30) or to the NBCA plus iodized oil group (n = 30). Interim analysis revealed faster and superior liver hypertrophy for the NBCA plus iodized oil group versus the PVA particles plus coils group 14 days and 28 days after PVE (absolute hypertrophy of 46% vs 30% [P < .001] and 57% vs 37% [P < .001], respectively). Liver growth for the proposed hepatectomy was achieved in 87% of participants (26 of 30) in the NBCA plus iodized oil group versus 53% of participants (16 of 30) in the PVA particles plus coils group (P = .008) 14 days after PVE. Liver failure occurred in 13% of participants (three of 24) in the NBCA plus iodized oil group and in 27% of participants (six of 22) in the PVA particles plus coils group (P = .27). Conclusion Portal vein embolization with N-butyl-cyanoacrylate plus iodized oil produced greater and faster liver growth as seen at CT in participants with liver cancer, compared with portal vein embolization with polyvinyl alcohol particles plus coils, allowing for earlier surgical intervention. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Arellano in this issue.
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Affiliation(s)
- José Hugo Mendes Luz
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Filipe Veloso Gomes
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Nuno Vasco Costa
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Inês Vasco
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Elia Coimbra
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Paula Mendes Luz
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Hugo Pinto Marques
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - João Santos Coelho
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Raquel Maria Alexandre Mega
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Vasco Nuno Torres Vouga Ribeiro
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Jorge Tiago Rodrigues da Costa Lamelas
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Maria Mafalda de Sampaio Nunes E Sobral
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Sílvia Raquel Gomes da Silva
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Ana Sofia de Teixeira Carrelha
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Susana Cristina Cardoso Rodrigues
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - António Augusto Ferreira Pinto de Figueiredo
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Margarida Varela Santos
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
| | - Tiago Bilhim
- From the Interventional Radiology Unit (J.H.M.L., F.V.G., N.V.C., I.V., E.C., T.B.), Hepato-Biliary-Pancreatic and Transplantation Center (H.P.M., J.S.C., R.M.A.M., V.N.T.V.R., J.T.R.d.C.L., M.M.d.S.N.e.S., S.R.G.d.S., A.S.d.T.C., S.C.C.R.), and Department of Pathology (A.A.F.P.d.F., M.V.S.), Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central (CHULC), Rua Beneficência 8, 1069-166, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal (J.H.M.L., F.V.G., N.V.C., I.V., T.B.); and National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (P.M.L.)
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Induction of liver hypertrophy for extended liver surgery and partial liver transplantation: State of the art of parenchyma augmentation-assisted liver surgery. Langenbecks Arch Surg 2021; 406:2201-2215. [PMID: 33740114 PMCID: PMC8578101 DOI: 10.1007/s00423-021-02148-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
Background Liver surgery and transplantation currently represent the only curative treatment options for primary and secondary hepatic malignancies. Despite the ability of the liver to regenerate after tissue loss, 25–30% future liver remnant is considered the minimum requirement to prevent serious risk for post-hepatectomy liver failure. Purpose The aim of this review is to depict the various interventions for liver parenchyma augmentation–assisting surgery enabling extended liver resections. The article summarizes one- and two-stage procedures with a focus on hypertrophy- and corresponding resection rates. Conclusions To induce liver parenchymal augmentation prior to hepatectomy, most techniques rely on portal vein occlusion, but more recently inclusion of parenchymal splitting, hepatic vein occlusion, and partial liver transplantation has extended the technical armamentarium. Safely accomplishing major and ultimately total hepatectomy by these techniques requires integration into a meaningful oncological concept. The advent of highly effective chemotherapeutic regimen in the neo-adjuvant, interstage, and adjuvant setting has underlined an aggressive surgical approach in the given setting to convert formerly “palliative” disease into a curative and sometimes in a “chronic” disease.
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Konishi T, Takamoto T, Hashimoto T, Makuuchi M. Is portal vein embolization safe and effective for patients with impaired liver function? J Surg Oncol 2021; 123:1742-1749. [PMID: 33657243 DOI: 10.1002/jso.26447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Portal vein embolization (PVE) is a safe and effective procedure used to increase the safety of extensive hepatectomy for selected patients. However, it is unknown whether PVE is safe for patients with impaired liver functional reserve. METHODS Patients who underwent PVE from April 2007 to September 2016 in our hospital were retrospectively assessed. According to indocyanine green retention rate at 15 min (ICG-R15), we divided patients into Group A (≤10%), Group B (10%-20%), and Group C (>20%). We described and compared the treatment course and the outcome among the three groups. RESULTS A total of 106 patients were assessed and divided into groups A (n = 46), B (n = 49), and C (n = 11). The morbidity and mortality after PVE showed no significant differences among the three groups (A:B:C = 37%:53%:64%, p = .16; A:B:C = 0%:0%:0%, p = 1.00, respectively). The morbidity and mortality after successive hepatectomy also showed no significant differences among the three groups (A:B:C = 55%:71%:78%, p = .19; A:B:C = 0%:2%:0%, p = 1.00, respectively). CONCLUSION A patient with impaired liver functional reserve (ICG-R15 > 20%) can be a candidate for PVE and successive hepatectomy, as safely as a patient with normal and slightly impaired liver functional reserve (ICG-R15 ≤ 20%).
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeshi Takamoto
- Division of Hepato-Biliary-Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takuya Hashimoto
- Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Ali A, Ahle M, Björnsson B, Sandström P. Portal vein embolization with N-butyl cyanoacrylate glue is superior to other materials: a systematic review and meta-analysis. Eur Radiol 2021; 31:5464-5478. [PMID: 33501598 DOI: 10.1007/s00330-020-07685-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/16/2020] [Accepted: 12/31/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES It remains uncertain which embolization material is best for portal vein embolization (PVE). We investigated the various materials for effectiveness in inducing future liver remnant (FLR) hypertrophy, technical and growth success rates, and complication and resection rates. METHODS A systematic review from 1998 to 2019 on embolization materials for PVE was performed on Pubmed, Embase, and Cochrane. FLR growth between the two most commonly used materials was compared in a random effects meta-analysis. In a separate analysis using local data (n = 52), n-butyl cyanoacrylate (NBCA) was compared with microparticles regarding costs, radiation dose, and procedure time. RESULTS In total, 2896 patients, 61.0 ± 4.0 years of age and 65% male, from 51 papers were included in the analysis. In 61% of the patients, either NBCA or microparticles were used for embolization. The remaining were treated with ethanol, gelfoam, or sclerosing agents. The FLR growth with NBCA was 49.1% ± 29.7 compared to 42.2% ± 40 with microparticles (p = 0.037). The growth success rate with NBCA vs microparticles was 95.3% vs 90.7% respectively (p < 0.001). There were no differences in major complications between NBCA and microparticles. In the local analysis, NBCA (n = 41) entailed shorter procedure time and reduced fluoroscopy time (p < 0.001), lower radiation exposure (p < 0.01), and lower material costs (p < 0.0001) than microparticles (n = 11). CONCLUSION PVE with NBCA seems to be the best choice when combining growth of the FLR, procedure time, radiation exposure, and costs. KEY POINTS • The meta-analysis shows that n-butyl cyanoacrylate (NBCA) is superior to microparticles regarding hypertrophy of the future liver remnant, 49.1% ± 29.7 vs 42.2% ± 40.0 (p = 0.037). • There is no significant difference in major complication rates for portal vein embolization using NBCA, 4% (24/681), compared with microparticles, 5% (25/494) (p > 0.05). • Local data shows a shorter procedure time, 215 vs 348 mins from arrival to departure at the interventional radiology unit, and fluoroscopy time, 43 vs 96 mins (p < 0.001), lower radiation dosage, 573 vs 1287 Gycm2 (p < 0.01), and costs, €816 vs €4233 (p < 0.0001) for NBCA compared to microparticles.
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Affiliation(s)
- Adnan Ali
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Margareta Ahle
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Bergthor Björnsson
- Department of Surgery and Clinical and Experimental Medicine, University Hospital of Linköping, Linköping, Sweden
| | - Per Sandström
- Department of Surgery and Clinical and Experimental Medicine, University Hospital of Linköping, Linköping, Sweden
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Masthoff M, Katou S, Köhler M, Schindler P, Heindel W, Wilms C, Schmidt HH, Pascher A, Struecker B, Wildgruber M, Morgul H. Portal and hepatic vein embolization prior to major hepatectomy. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:35-42. [PMID: 33429448 DOI: 10.1055/a-1330-9450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To analyze safety and effectiveness of simultaneous portal and hepatic vein embolization (PHVE) or sequential hepatic vein embolization (HVE) compared to portal vein embolization (PVE) for future remnant liver (FRL) hypertrophy prior to major hepatic surgery. METHODS Patients undergoing PVE, PHVE or HVE at our tertiary care center between 2018 and 2020 were retrospectively included. FRLV, standardized FRLV (sFRLV) and sFRLV growth rate per day were assessed via volumetry, as well as laboratory parameters. RESULTS 36 patients (f = 15, m = 21; median 64.5 y) were included, 16 patients received PHVE and 20 patients PVE, of which 4 received sequential HVE. Significant increase of FRLV was achieved with both PVE and PHVE compared to baseline (p < 0.0001). sFRLV growth rate did not significantly differ following PHVE (2.2 ± 1.2 %/d) or PVE (2.2 ± 1.7 %/d, p = 0.94). Left portal vein thrombosis (LPVT) was observed after PHVE in 6 patients and in 1 patient after PVE. Sequential HVE showed a considerably high growth rate of 1.42 ± 0.45 %/d after PVE. CONCLUSION PHVE effectively induces FRL hypertrophy but yields comparable sFRLV to PVE. Sequential HVE further induces hypertrophy after insufficient growth due to PVE. Considering a potentially higher rate of LPVT after PHVE, PVE might be preferred in patients with moderate baseline sFRLV, with optional sequential HVE in non-sufficient responders.
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Affiliation(s)
- Max Masthoff
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Shadi Katou
- Department for General, Visceral and Transplantation Surgery, University Hospital Muenster, Muenster, Germany
| | - Michael Köhler
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Philipp Schindler
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Walter Heindel
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany
| | - Christian Wilms
- Department of Gastroenterology and Hepatology, University Hospital Muenster, Muenster, Germany
| | - Hartmut H Schmidt
- Department of Gastroenterology and Hepatology, University Hospital Muenster, Muenster, Germany
| | - Andreas Pascher
- Department for General, Visceral and Transplantation Surgery, University Hospital Muenster, Muenster, Germany
| | - Benjamin Struecker
- Department for General, Visceral and Transplantation Surgery, University Hospital Muenster, Muenster, Germany
| | - Moritz Wildgruber
- Clinic of Radiology, University Hospital Muenster, Muenster, Germany.,Department of Radiology, University Hospital Ludwig-Maximilians-Universität, Munich, Germany
| | - Haluk Morgul
- Department for General, Visceral and Transplantation Surgery, University Hospital Muenster, Muenster, Germany
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Nitta H, Allard MA, Sebagh M, Golse N, Ciacio O, Pittau G, Vibert E, Sa Cunha A, Cherqui D, Castaing D, Bismuth H, Baba H, Adam R. Ideal Surgical Margin to Prevent Early Recurrence After Hepatic Resection for Hepatocellular Carcinoma. World J Surg 2021; 45:1159-1167. [PMID: 33386452 DOI: 10.1007/s00268-020-05881-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 12/07/2022]
Abstract
BACKGROUNDS AND AIMS Postoperative early recurrence after hepatic resection for hepatocellular carcinoma (HCC) poses a challenge to surgeons, and the effect of a surgical margin is still controversial. This study aimed to identify an ideal margin to prevent early recurrence. METHODS A total of 226 consecutive patients who underwent primary curative hepatic resection for solitary and primary HCC were enrolled. The definition of early recurrence was determined using the minimum P value approach. Logistic regression analysis was used to identify the risk factors of early recurrence. The receiver-operating characteristic (ROC) curve was used to identify the optimal cut-off of the surgical margin and early recurrence. RESULTS Recurrence within 8 months induced the poorest overall survival (P = 2×10-15). ROC analysis showed that the optimal cut-off value of the surgical margin was 7 mm. The risk factors of early recurrence (≤ 8-month recurrence) were preoperative alpha-fetoprotein levels ≥ 100 ng/ml (Odds ratio [OR] 4.92 [2.28-10.77], P < 0.0001) and a surgical margin < 7 mm (OR 3.09 [1.26-8.85], P = 0.01) by multivariable analysis. The probability of early recurrence ranged from 5.0% in the absence of any factors to 43.5% in the presence of both factors. Among patients with alpha-fetoprotein levels ≥ 100 ng/ml, non-capsule formation, or microvascular invasion, there was a significant difference in 5-year overall survival between surgical margins of < 7 mm and ≥ 7 mm. CONCLUSIONS A > 7-mm margin is important to prevent early recurrence. Patients with HCC and alpha-fetoprotein levels > 100 ng/ml, non-capsule formation, or microvascular invasion may have a survival benefit from a ≥ 7-mm margin.
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Affiliation(s)
- Hidetoshi Nitta
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France. .,Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Marc-Antoine Allard
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Mylène Sebagh
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Nicolas Golse
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Oriana Ciacio
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Gabriella Pittau
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Eric Vibert
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Antonio Sa Cunha
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Daniel Cherqui
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Denis Castaing
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Henri Bismuth
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - René Adam
- The Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Univ Paris Sud, Inserm U 935 and U 1193, 9 avenue Paul Vaillant Couturier, 94804, Villejuif, France
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Ke L, Shen R, Fan W, Hu W, Shen S, Li S, Kuang M, Liang L, Li J, Peng B, Hua Y. The role of associating liver partition and portal vein ligation for staged hepatectomy in unresectable hepatitis B virus-related hepatocellular carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1402. [PMID: 33313147 PMCID: PMC7723523 DOI: 10.21037/atm-20-2420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for hepatocellular carcinoma (HCC) remains controversial. Methods The records of 23 consecutive patients with hepatitis B virus (HBV)-related HCC who underwent ALPPS at our center between November 2013 and June 2018 were retrospectively reviewed. Oncological results were compared between patients who received ALPPS and those that received transarterial chemoembolization (TACE) using propensity score matching (PSM) analysis. Results In patients with a single tumor (n=12) the median tumor diameter was 13.0 (range: 5.1–20.0) cm, whereas in patients with multiple tumors (n=11) the median total tumor diameter was 6.3 (range: 2.3–26.0) cm. After the stage-1 ALPPS, the median future liver remnant (FLR) increased by 50.0%. The stage-2 ALPPS was completed in 20 patients (87.0%) after a median of 12 days. The 90-day mortality rate was 13% (3/23). The overall survival (OS) rates at 1-, 2-, and 5-year were 61.1%, 34.9%, and 8.7%, respectively, whereas the disease-free survival (DFS) rates at 1-, 2-, and 5-year were 27.8%, 27.8%, and 0.0%, respectively. PSM analysis showed no difference in OS between patients who underwent ALPPS and those that received TACE [P=0.178, Barcelona Clinic Liver Cancer (BCLC) stage A–C patients; P=0.241, BCLC stage B and C patients]. Conclusions ALPPS is a safe and effective treatment option for unresectable HBV-related HCC. However, for HBV-related intermediate and advanced HCC patients, ALPPS may not be superior to TACE.
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Affiliation(s)
- Lixin Ke
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Shen
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenzhe Fan
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenjie Hu
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shunli Shen
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoqiang Li
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Kuang
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lijian Liang
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaping Li
- Department of Interventional Oncology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baogang Peng
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yunpeng Hua
- Department of Liver Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Abstract
Patients with hepatocellular carcinoma (HCC) have many treatment options. For patients with surgical indication, consideration of future liver remnant and the surgical complexity of the procedure is essential. A new 3-level complexity classification categorizing 11 liver resection procedures predicts surgical complexity and postoperative morbidity better than reported classifications. Preoperative portal vein embolization can mitigate the risk of hepatic insufficiency. For small HCCs, both liver resection and ablation are effective. New medical treatment options are promising and perioperative use of these drugs may further improve outcomes for patients undergoing liver resection and lead to changes in current treatment guidelines.
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Affiliation(s)
- Yoshikuni Kawaguchi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX 77030, USA; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX 77030, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX 77030, USA.
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Gaillard M, Hornez E, Lecuelle B, Lilin T, Dubart-Kupperschmitt A, Dagher I, Tranchart H. Liver Regeneration and Recanalization Time Course following Repeated Reversible Portal Vein Embolization in Swine. Eur Surg Res 2020; 61:62-71. [PMID: 33049754 DOI: 10.1159/000509713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Portal vein embolization (PVE) is an accepted technique to preoperatively increase the volume of the future remnant liver before major hepatectomy. A permanent material is usually preferred since its superiority to induce liver hypertrophy over absorbable material has been demonstrated. Nevertheless, the use of an absorbable material generates a reversible PVE (RPVE) capable of inducing significant liver hypertrophy. In small animal models, the possibility to proceed to a repeated RPVE (RRPVE) has shown to boost liver hypertrophy further. The aim of this preliminary study was to assess the feasibility and the tolerance of RRPVE in a large animal model, in comparison with permanent PVE (PPVE) and single RPVE. METHODS Six swine (2 per group) were assigned either to single RPVE group (using powdered gelatin sponge), RRPVE group (2 RPVEs separated by 14 days) or PPVE group (using N-butyl-cyanoacrylate). The feasibility and tolerance of the procedures were evaluated using portography, liver function tests and histological analysis. Evolution of liver volumes was assessed with volumetric imaging by computed tomography. RESULTS Embolization of portal branches corresponding to 75% of total liver volume was performed successfully in all animals. Procedures were well tolerated, inducing moderate changes in portal pressure and transient aminotransferase increase. None of the animals developed portal vein thrombosis. After RPVE, complete recanalization occurred at day 11. RRPVE showed a trend for higher hypertrophy, the non-embolized liver to total liver ratio reaching 5.2 ± 1.0% in the RPVE group, 6.8 ± 0.1% in the RRPVE group and 5.0 ± 0.3% in the PPVE group. DISCUSSION/CONCLUSION In this preliminary comparative study, RRPVE was as feasible and as well tolerated as the other procedures, and resulted in higher liver hypertrophy.
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Affiliation(s)
- Martin Gaillard
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Paul Brousse Hospital, Villejuif, France, .,Département Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France, .,Faculté de Médecine Paris-Sud, Paris-Saclay University, Orsay, France, .,Department of Minimally Invasive Surgery, Antoine Béclère Hospital, APHP, Clamart, France,
| | - Emmanuel Hornez
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Paul Brousse Hospital, Villejuif, France.,Département Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France.,Department of Minimally Invasive Surgery, Antoine Béclère Hospital, APHP, Clamart, France
| | - Benoit Lecuelle
- Center for Biomedical Research, Ecole Nationale Vétérinaire d'Alfort, Maisons Alfort, France
| | - Thomas Lilin
- Center for Biomedical Research, Ecole Nationale Vétérinaire d'Alfort, Maisons Alfort, France
| | - Anne Dubart-Kupperschmitt
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Paul Brousse Hospital, Villejuif, France.,Département Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France.,Faculté de Médecine Paris-Sud, Paris-Saclay University, Orsay, France
| | - Ibrahim Dagher
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Paul Brousse Hospital, Villejuif, France.,Département Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France.,Faculté de Médecine Paris-Sud, Paris-Saclay University, Orsay, France.,Department of Minimally Invasive Surgery, Antoine Béclère Hospital, APHP, Clamart, France
| | - Hadrien Tranchart
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1193, Paul Brousse Hospital, Villejuif, France.,Département Hospitalo-Universitaire Hepatinov, Paul Brousse Hospital, Villejuif, France.,Faculté de Médecine Paris-Sud, Paris-Saclay University, Orsay, France.,Department of Minimally Invasive Surgery, Antoine Béclère Hospital, APHP, Clamart, France
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Azoulay D, Ramos E, Casellas-Robert M, Salloum C, Lladó L, Nadler R, Busquets J, Caula-Freixa C, Mils K, Lopez-Ben S, Figueras J, Lim C. Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. JHEP Rep 2020; 3:100190. [PMID: 33294830 PMCID: PMC7689549 DOI: 10.1016/j.jhepr.2020.100190] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023] Open
Abstract
Background & Aims Liver resection (LR) in patients with hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH) defined as a hepatic venous pressure gradient (HVPG) ≥10 mmHg is not encouraged. Here, we reappraised the outcomes of patients with cirrhosis and CSPH who underwent LR for HCC in highly specialised liver centres. Methods This was a retrospective multicentre study from 1999 to 2019. Predictors for postoperative liver decompensation and textbook outcomes were identified. Results In total, 79 patients with a median age of 65 years were included. The Child-Pugh grade was A in 99% of patients, and the median model for end-stage liver disease (MELD) score was 8. The median HVPG was 12 mmHg. Major hepatectomies and laparoscopies were performed in 28% and 34% of patients, respectively. Ninety-day mortality and severe morbidity rates were 6% and 27%, respectively. Postoperative and persistent liver decompensation occurred in 35% and 10% of patients at 3 months. Predictors of liver decompensation included increased preoperative HVPG (p = 0.004), increased serum total bilirubin (p = 0.02), and open approach (p = 0.03). Of the patients, 34% achieved a textbook outcome, of which the laparoscopic approach was the sole predictor (p = 0.004). The 5-year overall survival and recurrence-free survival rates were 55% and 43%, respectively. Conclusions Patients with cirrhosis, HCC and HVPG ≥10 mmHg can undergo LR with acceptable mortality, morbidity, and liver decompensation rates. The laparoscopic approach was the sole predictor of a textbook outcome. Lay summary Patients with cirrhosis, hepatocellular carcinoma, and clinically significant portal hypertension (defined as a hepatic venous pressure gradient ≥10 mmHg) can undergo resection with acceptable mortality, morbidity, liver decompensation rates, and a textbook outcome. These results can be achieved in selected patients with preserved liver function, good general status, and sufficient remnant liver volume.
Patients with HCC and CSPH can undergo resection, with mortality of 6% and severe morbidity of 27%. Postoperative and persistent liver decompensation occurred in 35% and 10% of patients, respectively. Textbook outcome was achieved in 34% of patients. The laparoscopic approach was identified as a predictor of postoperative liver decompensation and textbook outcome.
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Key Words
- AFP, alpha-fetoprotein
- ASA, American Society of Anesthesiologists
- BCLC, Barcelona-Clinic Liver Cancer
- CCI, Comprehensive Complication Index
- CSPH, clinically significant portal hypertension
- CT, computed tomography
- Clinically significant portal hypertension
- EASL, European Association for the Study of the Liver
- HVPG, hepatic venous pressure gradient
- Hepatectomy
- Hepatic venous pressure gradient
- LLR, laparoscopic liver resection
- LR, liver resection
- MELD, model for end-stage liver disease
- PHT, portal hypertension
- PVE, portal vein embolisation
- Postoperative liver decompensation
- TACE, transarterial chemoembolisation
- Textbook outcome
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Affiliation(s)
- Daniel Azoulay
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France.,Department of Hepato-Biliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Emilio Ramos
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain
| | - Margarida Casellas-Robert
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari Dr Josep Trueta, Girona, Catalonia, Spain
| | - Chady Salloum
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Laura Lladó
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain
| | - Roy Nadler
- Department of Hepato-Biliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Juli Busquets
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain
| | - Celia Caula-Freixa
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari Dr Josep Trueta, Girona, Catalonia, Spain
| | - Kristel Mils
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain
| | - Santiago Lopez-Ben
- Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari Dr Josep Trueta, Girona, Catalonia, Spain
| | - Joan Figueras
- Hepato-Biliary and Pancreatic Surgery, Department of Surgery, "Sagrat Cor" Hospital University of Barcelona, Barcelona, Spain
| | - Chetana Lim
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
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Schwarz L, Nicol L, Francois A, Mulder P, Faitot F, Dazza M, Bucur P, Savoye-Collet C, Adam R, Vibert E. Major hepatectomy decreased tumor growth in an experimental model of bilobar liver metastasis. HPB (Oxford) 2020; 22:1480-1489. [PMID: 32156510 DOI: 10.1016/j.hpb.2020.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/15/2019] [Accepted: 02/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE Two-stage hepatectomy (TSH), is associated with a risk of drop-out due to tumoral progression following portal vein occlusion (PVO). We explored the impact of majorhepatectomy on tumor growth by objective radiological measures comparing to PVO and minor hepatectomy, using a model of bilobar colorectal liver metastasis (CLM). METHODS CLM were induced in 48 BDIX rats by injection of DHDK12-cells. 7 days after cells injection, animals were distributed into 4 groups of equal number (n = 12): portal vein ligation (PVL), sham laparotomy (sham), minor (30%Phx) and major (70%Phx) hepatectomy. MR imaging was used for in vivo analysis of tumor implantation, growth and volumes. RESULTS At POD10, tumour volumes were homogeneously distributed among the 4 groups. Lower TV were significantly observed after 70%Phx comparing to PVL at POD17 (0.63 ± 0.14cm3 vs 0.9 ± 0.16cm3, p = 0.008) and to the 3 others groups at POD24: 1.78 ± 0.38cm3 vs 3.2 ± 0.62cm3 (PVL, p = 0.019), 2.41 ± 0.74cm3 (Sham, p = 0.024) and 2.32 ± 0.59cm3 (30%PHx, p = 0.019). CONCLUSION We confirmed in a reproducible model that contrary to PVO, a major hepatectomy decreases the growth of CLM in the remnant liver. This result leads to questioning the usual TSH and justifies exploring alternative strategies. The "major hepatectomy first-approach" should be an option to be evaluated.
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Affiliation(s)
- Lilian Schwarz
- Rouen University Hospital, Department of Digestive Surgery, 1 Rue de Germont, F-76031, Rouen Cedex, France; Normandie Univ, UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, F-76000, Rouen, France.
| | - Lionel Nicol
- Normandie Univ, UNIROUEN, Inserm U1096, FHU- REMOD-VHF, 76000 Rouen, France
| | - Arnaud Francois
- Rouen University Hospital, Department of Pathology, 1 Rue de Germont, F-76031, Rouen Cedex, France
| | - Paul Mulder
- Normandie Univ, UNIROUEN, Inserm U1096, FHU- REMOD-VHF, 76000 Rouen, France
| | - François Faitot
- Strasbourg University Hospital, Hôpital Hautepierre, Department of hepatobiliary and liver transplantation surgery, France
| | - Marie Dazza
- Rouen University Hospital, Department of Digestive Surgery, 1 Rue de Germont, F-76031, Rouen Cedex, France
| | - Petru Bucur
- Tours University Hospital, Department of Digestive Surgery and Liver Transplantation, France
| | - Céline Savoye-Collet
- Rouen University Hospital, Department of Radiology, 1 Rue de Germont, F-76031, Rouen Cedex, France; Normandie Univ, UNIROUEN, Quantif-LITIS EA 4108, Rouen University Hospital, France
| | - René Adam
- Department of Hepatobiliary and Liver Transplantation - Paul Brousse University Hospital, France
| | - Eric Vibert
- Department of Hepatobiliary and Liver Transplantation - Paul Brousse University Hospital, France
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Ferrante ND, Pillai A, Singal AG. Update on the Diagnosis and Treatment of Hepatocellular Carcinoma. Gastroenterol Hepatol (N Y) 2020; 16:506-516. [PMID: 34017223 PMCID: PMC8132669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hepatocellular carcinoma (HCC) is the fourth-leading cause of cancer-related mortality worldwide and the fastest-rising cause of cancer-related death in the United States. Given the strong association between tumor stage and prognosis, HCC surveillance is recommended in high-risk patients, including patients with cirrhosis from any etiology. The diagnosis can be made based on characteristic imaging findings, with histologic confirmation primarily reserved for patients with atypical imaging findings. Over the last 2 decades, the treatment landscape for HCC has experienced significant advances. Curative therapies, including liver transplantation and surgical resection, are available to patients with early-stage HCC; however, recent data have expanded the potentially eligible patient population. Locoregional therapies, including transarterial chemoembolization and transarterial radio-embolization, continue to be standard therapies for patients with intermediate-stage disease. The greatest advances have been observed for patients with advanced HCC, where there are now multiple first- and second-line options that can prolong survival by up to 2 years when used sequentially. The increasing complexity of HCC treatment options underlies the necessity for multidisciplinary care, which has been associated with increased survival. This article reviews data on best practices for early detection and diagnosis of HCC and the current status of treatment options.
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Affiliation(s)
- Nicole D. Ferrante
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics; Center for Clinical Epidemiology and Biostatistics; Center for Pharmacoepidemiology Research and Training; Perelman School of Medicine; University of Pennsylvania; Philadelphia; Pennsylvania
| | - Anjana Pillai
- Division of Gastroenterology and Hepatology, University of Chicago Medicine, Chicago, Illinois
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas
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Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham‐Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin KK, Aziz O, Baker RP, Bali M, Baseckas G, Bebington B, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo‐Marulanda A, Chan KKL, Chang GJ, Chew MH, Chong PC, Christensen HK, Clouston H, Codd M, Collins D, Colquhoun A, Corr A, Coscia M, Coyne PE, Creavin B, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Enrique‐Navascues JM, Espin‐Basany E, Evans MD, Fearnhead NS, Flatmark K, Fleming F, Frizelle FA, Gallego MA, Garcia‐Granero E, Garcia‐Sabrido JL, Gentilini L, George ML, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins JT, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kristensen HØ, Kroon HM, Kusters M, Lago V, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Lydrup ML, Lyons A, Lynch AC, Mantyh C, Mathis KL, Margues CFS, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McArthur DR, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Morton JR, Mullaney TG, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, O’Dwyer ST, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson AC, Poggioli G, Proud D, Quinn M, Quyn A, Radwan RW, van Ramshorst GH, Rasheed S, Rasmussen PC, Regenbogen SE, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Ryan ÉJ, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Hellawell G, Shida D, Simpson A, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Sumrien H, Sutton PA, Swartking T, Taylor C, Tekkis PP, Teras J, Thurairaja R, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Vasquez‐Jimenez W, Verhoef C, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Wheeler JMD, Wild J, Wilson M, de Wilt JHW, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, van Zoggel D, Winter DC. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative. Colorectal Dis 2020; 22:1258-1262. [PMID: 32294308 DOI: 10.1111/codi.15064] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 02/08/2023]
Abstract
AIM At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. METHOD Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. RESULTS Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). CONCLUSION Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
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Radiological Simultaneous Portohepatic Vein Embolization (RASPE) Before Major Hepatectomy: A Better Way to Optimize Liver Hypertrophy Compared to Portal Vein Embolization. Ann Surg 2020; 272:199-205. [PMID: 32675481 DOI: 10.1097/sla.0000000000003905] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this retrospective study was to compare portal vein embolization (PVE) and radiologica simultaneous portohepatic vein embolization (RASPE) for future liver remnant (FLR) growth in terms of feasibility, safety, and efficacy. SUMMARY OF BACKGROUND DATA After portal vein embolization (PVE), 15% of patients remain ineligible for hepatic resection due to insufficient hypertrophy of the FLR. RASPE has been proposed to induce FLR growth. MATERIALS AND METHODS Between 2016 and 2018, 73 patients were included in the study. RASPE was proposed for patients with a ratio of FLR to total liver volume (FLR/TLV) of <25% (RASPE group). This group was compared to patients who underwent PVE for a FLR/TLV <30% (PVE group). Patients in the 2 groups were matched for age, sex, type of tumor, and number of chemotherapy treatments. FLR was assessed by computed tomography before and 4 weeks after the procedure. RESULTS The technical success rate in both groups was 100%. Morbidity post-embolization, and the time between embolization and surgery were similar between the groups. In the PVE group, the FLR/TLV ratio before embolization was 31.03% (range: 18.33%-38.95%) versus 22.91% (range: 16.55-32.15) in the RASPE group (P < 0.0001). Four weeks after the procedure, the liver volume increased by 28.98% (range: 9.31%-61.23%) in the PVE group and by 61.18% (range: 23.18%-201.56%) in the RASPE group (P < 0.0001). Seven patients in the PVE group, but none in the RASPE group, had postoperative liver failure (P = 0.012). CONCLUSIONS RASPE can be considered as "radiological associating liver partition and portal vein ligation for staged hepatectomy." RASPE induced safe and profound growth of the FLR and was more efficient than PVE. RASPE also allowed for extended hepatectomy with less risk of post-operative liver failure.
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Zhang CW, Dou CW, Zhang XL, Liu XQ, Huang DS, Hu ZM, Liu J. Simultaneous transcatheter arterial chemoembolization and portal vein embolization for patients with large hepatocellular carcinoma before major hepatectomy. World J Gastroenterol 2020; 26:4489-4500. [PMID: 32874060 PMCID: PMC7438194 DOI: 10.3748/wjg.v26.i30.4489] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/10/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sequential transarterial chemoembolization (TACE) and portal vein embolization (PVE) are associated with long time interval that can allow tumor growth and nullify treatments' benefits.
AIM To evaluate the effect of simultaneous TACE and PVE for patients with large hepatocellular carcinoma (HCC) prior to elective major hepatectomy.
METHODS Fifty-one patients with large HCC who underwent PVE combined with or without TACE prior to hepatectomy were included in this study, with 13 patients in the simultaneous TACE + PVE group, 17 patients in the sequential TACE + PVE group, and 21 patients in the PVE-only group. The outcomes of the procedures were compared and analyzed.
RESULTS All patients underwent embolization. The mean interval from embolization to surgery, the kinetic growth rate of the future liver remnant (FLR), the degree of tumor size reduction, and complete tumor necrosis were significantly better in the simultaneous TACE + PVE group than in the other groups. Although the patients in the simultaneous TACE + PVE group had a higher transaminase levels after PVE and TACE, they recovered to comparable levels with the other two groups before surgery. The intraoperative course and the complication and mortality rates were similar among the three groups. The overall survival and disease-free survival were higher in the simultaneous TACE + PVE group than in the other two groups.
CONCLUSION Simultaneous TACE and PVE is a safe and effective approach to increase FLR volume for patients with large HCC before major hepatectomy.
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Affiliation(s)
- Cheng-Wu Zhang
- Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Chang-Wei Dou
- Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Xin-Long Zhang
- Department of General Surgery, Aksu Area First Hospital, Aksu 843000, Xinjiang Uygur Autonomous Region, China
| | - Xi-Qiang Liu
- Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Dong-Shen Huang
- Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Zhi-Ming Hu
- Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Jie Liu
- Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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Allaire M, Goumard C, Lim C, Le Cleach A, Wagner M, Scatton O. New frontiers in liver resection for hepatocellular carcinoma. JHEP Rep 2020; 2:100134. [PMID: 32695968 PMCID: PMC7360891 DOI: 10.1016/j.jhepr.2020.100134] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 04/23/2020] [Accepted: 05/15/2020] [Indexed: 02/08/2023] Open
Abstract
Liver resection is one of the main curative options for early hepatocellular carcinoma (HCC) in patients with cirrhosis and is the treatment of choice in non-cirrhotic patients. However, careful patient selection is required to balance the risk of postoperative liver failure and the potential benefit on long-term outcomes. In the last decades, improved surgical techniques and perioperative management, as well as better patient selection, have enabled the indications for liver resection to be expanded. In this review, we aim to describe the main indications for liver resection in the management of HCC, its role compared to percutaneous ablation and liver transplantation in the therapeutic algorithm, as well as the recent advances in liver surgery that could be used to improve the prognosis of patients with HCC.
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Key Words
- ALPPS, associating liver partition and portal vein ligation for staged hepatectomy
- BCLC, Barcelona Clinic liver cancer
- CSPH, clinically significant portal hypertension
- DFS, disease-free survival
- GSA, galactosyl serum albumin
- HCC
- HCC, hepatocellular carcinoma
- HVGP, hepatic venous pression gradient
- ICG, indocyanine green
- ICG-R15, hepatic clearance of ICG 15 minutes after its intravenous administration
- IL-6, interleukin 6
- LR, liver resection
- LSM, liver stiffness measurement
- Laparoscopy
- Liver resection
- MELD, model for end-stage liver disease
- NAFLD, non-alcoholic fatty liver disease
- OS, overall survival
- PVL, portal vein ligation
- PVTT, tumour-related portal vein thrombosis
- RFA, radiofrequency ablation
- SSM, spleen stiffness measurement
- Surgery
- TACE, transarterial chemoembolisation
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Affiliation(s)
- Manon Allaire
- Sorbonne Université, Service d'Hépatologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
- Inserm U1149, Centre de Recherche sur l'Inflammation, France Faculté de Médecine Xavier Bichat, Université Paris Diderot, Paris, France
| | - Claire Goumard
- Sorbonne Université, CRSA, Service de chirurgie digestive, hépato-biliaire et transplantation hépatique, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Chetana Lim
- Sorbonne Université, CRSA, Service de chirurgie digestive, hépato-biliaire et transplantation hépatique, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Aline Le Cleach
- Sorbonne Université, Service d'Hépatologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Mathilde Wagner
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), Service de Radiologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Olivier Scatton
- Sorbonne Université, CRSA, Service de chirurgie digestive, hépato-biliaire et transplantation hépatique, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
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Chan A, Kow A, Hibi T, Di Benedetto F, Serrablo A. Liver resection in Cirrhotic liver: Are there any limits? Int J Surg 2020; 82S:109-114. [PMID: 32652296 DOI: 10.1016/j.ijsu.2020.06.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/21/2020] [Accepted: 06/30/2020] [Indexed: 01/27/2023]
Abstract
Liver resection remains one of the most technically challenging surgical procedure in abdominal surgery due to the complex anatomical arrangement in the liver and its rich blood supply that constitutes about 20% of the cardiac output per cycle. The challenge for resection in cirrhotic livers is even higher because of the impact of surgical stress and trauma imposed on borderline liver function and the impaired ability for liver regeneration in cirrhotic livers. Nonetheless, evolution and advancement in surgical techniques as well as knowledge in perioperative management of liver resection has led to a substantial improvement in surgical outcome in recent decade. The objective of this article was to provide updated information on the recent developments in liver surgery, from preoperative evaluation, to technicality of resection, future liver remnant augmentation and finally, postoperative management of complications.
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Affiliation(s)
- Albert Chan
- Division of Hepatobiliary & Pancreatic Surgery, & Liver Transplantation, Department of Surgery, The University of Hong Kong, & State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China.
| | - Alfred Kow
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University of Singapore, Singapore
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Japan
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Alejandro Serrablo
- Chairman of HPB Surgical Division. Miguel Servet University Hospital. Zaragoza, Spain
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Nitta H, Kitano Y, Miyata T, Nakagawa S, Mima K, Okabe H, Hayashi H, Imai K, Yamashita YI, Chikamoto A, Beppu T, Baba H. Validation of Functional Assessment for Liver Resection Considering Venous Occlusive Area after Extended Hepatectomy. J Gastrointest Surg 2020; 24:1510-1519. [PMID: 31144188 DOI: 10.1007/s11605-019-04234-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/15/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies demonstrated that liver function in a veno-occlusive region is approximately 40% of that in a non-veno-occlusive region after hepatectomy with excision of major hepatic vein. We validated the preoperative assessment of future remnant liver (FRL) function based on 40% decreased function of the veno-occlusive region. METHODS Sixty patients who underwent hepatectomy with excision of major hepatic vein were analyzed. The FRL functions of the veno-occlusive and non-veno-occlusive regions were calculated with 99mTc-galactosyl human serum albumin scintigraphy single-proton emission computed tomography fusion system and SYNAPSE VINCENT® preoperatively. Risk assessment for hepatectomy was evaluated based on indocyanine green retention at 15 min, and patients with insufficient FRL function were described as marginal. RESULTS The median volume and function of the veno-occlusive region per whole liver were 111 ml and 11.0%, respectively. When the function of the veno-occlusive region was presumed as 0%, 40%, and 100%, the FRL function was 62.5%, 68.4%, and 75.0% and 21, 15, and 7 patients were classified as marginal, respectively. When the function of the veno-occlusive region was presumed as 40%, the posthepatectomy liver failure (PHLF) rate of marginal patients was significantly higher than that of safe patients (46.7% vs 8.9%, P = 0.002). Multivariable analysis indicated that marginal FRL function based on 40% decreased function of the veno-occlusive region was the only independent risk factor for PHLF (odds ratio 8.97, P = 0.002) after extended hepatectomy. CONCLUSION Assessment of preoperative FRL function based on 40% decreased function of the veno-occlusive region may have high validity.
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Affiliation(s)
- Hidetoshi Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Yuki Kitano
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Tatsunori Miyata
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kosuke Mima
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Toru Beppu
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan.,Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556, Japan
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Park GC, Lee SG, Yoon YI, Sung KB, Ko GY, Gwon DI, Jung DH, Jung YK. Sequential transcatheter arterial chemoembolization and portal vein embolization before right hemihepatectomy in patients with hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2020; 19:244-251. [PMID: 32414576 DOI: 10.1016/j.hbpd.2020.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent studies showed that sequential selective transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) provided better future liver remnant (FLR) regeneration rate and disease-free survival following surgery compared with PVE alone. The present study aimed to clarify whether preoperative sequential TACE and PVE before right hemihepatectomy can reduce postoperative hepatocellular carcinoma (HCC) recurrence and improve long-term disease-free and overall survival. METHODS Recurrence and survival outcomes were retrospectively evaluated in 205 patients with HCC who underwent right hemihepatectomy by a single surgeon from November 1993 to November 2017. Patients were divided into four groups according to the procedure performed before the surgery: sequential TACE and PVE (TACE-PVE), PVE-only, TACE-only, or naïve control groups. The baseline patient and tumor characteristics, postoperative outcomes, recurrence-free survival and overall survival were analyzed. RESULTS Baseline patient and tumor characteristics upon diagnosis were similar in all four groups, while sequential TACE and PVE were well tolerated. The TACE-PVE group had a higher mean increase in percentage FLR volume compared with that of the PVE-only group (17.46% ± 6.63% vs. 12.14% ± 5.93%; P = 0.001). The TACE-PVE group had significantly better overall and disease-free survival rates compared with the other groups (both P < 0.001). CONCLUSIONS Sequential TACE and PVE prior to surgery can be an effective therapeutic strategy for patients with HCC scheduled for major hepatic resection. The active application of preoperative sequential TACE and PVE for HCC would allow more patients with marginal FLR volume to become candidates for major hepatic resection by promoting compensatory FLR hypertrophy without the deterioration of basal hepatic functional reserve or tumor progression.
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Affiliation(s)
- Gil Chun Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Young In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyu Bo Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hwan Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Kyu Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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48
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Luz JHM, Bilhim T, Gomes FV, Costa NV, Coimbra E. Regarding: "Liver venous deprivation compared with portal vein embolization to induce hypertrophy of the future liver remnant before major hepatectomy: A single center experience". Surgery 2020; 168:976-977. [PMID: 32307096 DOI: 10.1016/j.surg.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Jose Hugo M Luz
- Interventional Radiology Unit, Curry Cabral Hospital, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
| | - Tiago Bilhim
- Interventional Radiology Unit, Curry Cabral Hospital, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Filipe V Gomes
- Interventional Radiology Unit, Curry Cabral Hospital, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nuno V Costa
- Interventional Radiology Unit, Curry Cabral Hospital, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Elia Coimbra
- Interventional Radiology Unit, Curry Cabral Hospital, Centro Hospitalar Universitário Lisboa Central, CHULC, Lisbon, Portugal
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49
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[Treatment of colorectal and non-colorectal liver metastases: rationale for neoadjuvant therapeutic concepts]. Chirurg 2020; 91:396-404. [PMID: 32291472 DOI: 10.1007/s00104-020-01133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Liver metastases represent the most common secondary malignant liver disease. Data regarding the incidence of colorectal and non-colorectal liver metastases are rare due to insufficient documentation in a register. Results regarding neoadjuvant therapy are limited and mostly from retrospective analyses. OBJECTIVE A summary and rating of the rationale for neoadjuvant therapeutic concepts for colorectal and non-colorectal liver metastases were performed. MATERIAL UND METHODS The analysis was based on European and American guidelines and included publications in both German and English languages. The results and recommendations were summarized and a review based on the literature is given. RESULTS Neoadjuvant treatment of liver metastases is performed with heterogeneous intentions. The selection of biologically favorable tumors as well as the conversion of primarily non-operable into resectable metastases of the liver are classical reasons for neoadjuvant treatment. The rationale for neoadjuvant treatment of colorectal and especially for non-colorectal liver metastases cannot be answered in a consistently coherent way with respect to the current status quo of the literature and guidelines. The creation of treatment strategies in clinical settings follows criteria, such as patterns of metastases, complexity of the resection and biological factors (metachronous/synchronous metastases, prognostic factors). CONCLUSION Neoadjuvant treatment in the context of conversion therapy is the standard procedure for metastasized colorectal cancer. The biological selection of favorable tumors as the basis for neoadjuvant treatment of resectable lesions is not a consistently used standard for colorectal cancer. Non-colorectal liver metastases are resected only as part of individual concepts.
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50
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Kim D, Cornman-Homonoff J, Madoff DC. Preparing for liver surgery with "Alphabet Soup": PVE, ALPPS, TAE-PVE, LVD and RL. Hepatobiliary Surg Nutr 2020; 9:136-151. [PMID: 32355673 DOI: 10.21037/hbsn.2019.09.10] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Future liver remnant (FLR) size and function is a critical limiting factor for treatment eligibility and postoperative prognosis when considering surgical hepatectomy. Pre-operative portal vein embolization (PVE) has been proven effective in modulating FLR and now widely accepted as a standard of care. However, PVE is not always effective due to potentially inadequate augmentation of the FLR as well as tumor progression while awaiting liver growth. These concerns have prompted exploration of alternative techniques: associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), transarterial embolization-portal vein embolization (TAE-PVE), liver venous deprivation (LVD), and radiation lobectomy (RL). The article aims to review the principles and applications of PVE and these newer hepatic regenerative techniques.
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Affiliation(s)
- DaeHee Kim
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua Cornman-Homonoff
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA
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