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Portal vein ligation with alcohol injection – our first experiences

Czech version

Authors: K. Menclová 1;  J. Malík 2;  J. Pudil 1;  F. Bělina 1;  M. Ryska 1
Authors‘ workplace: 1. Chirurgická klinika 2. lékařské fakulty Univerzity Karlovy a Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha 1;  Radiodiagnostické oddělení Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha 2
Published in: Rozhl. Chir., 2019, roč. 98, č. 9, s. 379-384.
Category: Case Report
doi: https://doi.org/10.33699/PIS.2019.98.9.379–384

Overview

Introduction: Surgical resection of colorectal liver metastases is a gold standard treatment. The indication criteria still continue expanding. The future liver remnant volume (FLRV) remains the only limiting factor of the resection. Many methods have been discussed to increase the FLRV. Injection of absolute alcohol into the portal vein seems to be one of the most effective.

Patients and methods: In 2018 we perioperatively injected 25 ml of absolute alcohol into the ligated right portal branch in 3 patients with colorectal liver metastases at our department. All patients were indicated for second-stage right hemihepatectomy.

Results: The mean FLRV increase was 206.6 cm3 4−6 weeks after absolute alcohol injection. A transient elevation of transaminases was observed with spontaneous regression within 10 days from alcohol injection. There was no complication clearly associated with alcohol application. No liver failure was observed. No patient died. All three patients underwent second-stage right hemihepatectomy.

Conclusion: Portal vein ligation with alcohol injection can be an uncomplicated and highly effective method to achieve FLRV hypertrophy.

Keywords:

embolization – portal vein ligation – liver volume – liver failure

Sources
  1. Národní onkologický registr; Available from: https://www.uzis.cz/registry-nzis/nor.
  2. Russolillo N, Langella S, Perotti S, et al. Alcohol injection into the portal vein prior to ligation increases liver regeneration rate. HPB 2018;20:739−44. doi: 10.1016/j.hpb.2018.02.637.
  3. Imai K, Benitez C, Adam R, et al. Failure to achieve a 2-stage hepatectomy for colorectal liver metastases how to prevent it? Annals of Surgery 2015;262:772−9. doi:10.1097/sla.0000000000001449. 
  4. Wichters D, de Haas R, Azoulay D, et al. Impact of portal vein embolization on long-term survival of patients with primarily unresectable colorectal liver metastases. Br J Surg. 2010;97:240−50. doi: 10.1002/bjs.6756.
  5. Kitano Y, Adam R. Multidisciplinary approach of liver metastases from colorectal cancer. Ann Gastroenterol Surg. 2019;14:50−6. doi: 10.1002/ags3.12227.
  6. Karoui M, Penna C, Amin-Hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg. 2006;243:1−7. doi: 10.1097/01.sla.0000193603.26265.c3.
  7. Pandanaboyana S, Bell R, Lodge JP, et al. A systematic review and meta-analysis of portal vein ligation versus portal vein embolization for elective liver resection. Surgery 2015;157:690−8. doi: 10.1016/j.surg.2014.12.009.
  8. Adam R, Wichters D, Castaing D, et al. Patients with initially unresectable colorectal liver metastases: is there a possibility of cure? J Clin Oncol. 2009;10;27:1829−35. doi: 10.1200/JCO.2008.19.9273.
  9. Castaing D, Adam R, Azoulay D. Chirugie du foie et de l´hypertension portale, Toulouse France, Masson 2006.
  10. Sakuhara Y, Abo D, Hasegawa Y, et al. Preoperative percutaneous transhepatic portal vein embolization with ethanol injection. AJR  2012;198:914−22. doi: 10.2214/AJR.11.6515.
  11. Denys A, Abehsera M, Sauvanet A, et al. Failure of right portal vein ligation to induce left lobe hypertrophy due to intrahepatic portoportal collaterals: Successful treatment with portal vein embolization. AJR 1999;173:633−5. doi: 10.2214/ajr.173.3.10470893.
  12. Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990;107:521−7.
  13. Kaminou T, Nakamura K, Usuki N, et al. Selective segmental sclerotherapy of the liver by transportal ethanol injection; A complete remission case of hepatocellular carcinoma. Nippon Act Radiol. 1990;50:11−17.
  14. Kinoshita H, Sakai K, Hirohashi K, et al. Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg. 1986;10: 803−8.
  15. Robles R, Marin C, Lopez-Conesa A, et al. Comparative study of right portal vein ligation versus embolization for induction of hypertrophy in two stage hepatectomy for multiple bilateral colorectal liver metastases. Eur J Surg Oncol. 2012;38:586−93. doi: 10.1016/j.ejso.2012.03.007.
  16. Matsuoka T, Nakatsuka H, Kobayashi N, et al. Portal vein embolization for hepatoma with lipiodol-fibrin adhesive mixture. [In Japanese] Nippon Act Radiol. 1984;44:1411−13.
  17. Elias D, Roche A, Vavasseur D, et al. Induction of hypertrophy of a small left hepatic lobe, before right extended hepatectomy, by preoperative right portal embolization. [In French] Ann Chir. 1992; 46:404−10.
  18. De Baere T, Roche A, Vavasseur D, et al. Portal vein embolization: utility for inducing left hepatic lobe hypertrophy before surgery. Radiology 1993;188:73−7. doi: 10.1148/radiology.188.1.8511321.
  19. Ellman BA, Parkhill BJ, Curry TS, et al. Ablation of renal tumors with absolute ethanol: a new technique. Radiology 1981;141:619−26.doi:10.1148/radiology.141.3.7302214.
  20. Rabe FE, Yune HY, Richmond BD, et al. Renal tumor infarction with absolute ethanol injection. AJR 1982;139:1139−44. doi:10.2214/ajr.139.6.1139.
  21. Shimamura T, Nakajima Y, Une Y, et al. Efficacy and safety of preoperative percutaneous transhepatic portal embolization with absolute ethanol: A clinical study. Surgery 1997;121:135−41.
  22. Ogasawara K, Uchino J, Une Y, et al. Selective portal vein embolization with absolute ethanol induces hepatic hypertrophy and makes more extensive hepatectomy possible. Hepatology 1996;23:338−45. doi: 10.1053/jhep.1996.v23.pm0008591861.
  23. Sofue K. Right portal vein embolization with absolute ethanol in major hepatic resection for hepatobiliary malignancy. Br J Surg. 2014;101:1122−8. doi: 10.1002/bjs.9541.
  24. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205−13. doi:10.1097/01.sla.0000133083.54934.ae.
  25. Menclová K, Pudil J, Ryska M, et al. Biliární leak po jaterních resekcích: retrospektivní analýza vlastního souboru. Rozhl Chir. 2015;94:516−21.
  26. Pohnan R, Ryska M, Hytych V, et al. Echinococcosis mimicking liver malignancy: A case report. Int J Surg Case Rep. 2017;36:55−8. doi: 10.1016/j.ijscr.2017.04.032.
  27. Isfordink CJ, Samim M, Braat MNGJA, et al. Portal vein ligation verus portal vein embolization for induction of hypertrophy of the future liver remnant: A systematic review and meta-analysis. Surg Oncol. 2017;26:257−67. doi: 10.1016/j.suronc.2017.05.001.
  28. Aussilhou B, Lesurtel M, Sauvanet A, et al. Right portal vein ligation is as efficient as portal vein embolization to induce hypertrophy of the left liver remnant. J Gastrointest Surg. 2008;12:297−303. doi:10.1007/s11605-007-0410-x.
  29. Capussotti L, Muratore A, Baracchi F, et al. Portal vein ligation as an efficient method of increasing the future liver remnant volume in the surgical treatment of colorectal metastases. Arch Surg. 2008;143:978−82.
  30. Krupski G, Bröring DC, Wittkugel O, et al. Formation of portal venous collaterals after ligation of the portal vein for induction of liver regeneration. [In German] Rofo. 2002;174:1281−4. doi: 10.1055/s-2002-34625.
  31. Elias D, De Baere T, Roche A, et al. During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than of the liver parenchyma. Br J Surg. 1999;86:784−8. doi: 10.1046/j.1365-2168.1999.01154.x.
  32. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst. 20002;92:205−16. doi: 10.1093/jnci/92.3.205.
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Article was published in

Perspectives in Surgery

Issue 9
2019 Issue 9
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