In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection
Posted on 2020-06-26 - 03:57
Abstract Background Right extended liver resection is frequently required to achieve tumor-free margins. Portal venous embolization (PVE) of the prospective resected hepatic segments for conditioning segments II/III does not always induce adequate hypertrophy in segments II and III (future liver remnant volume (FLRV)) for extended right-resection. Here, we present the technique of in situ split dissection along segments II/III plus portal disruption to segments IV-VIII (ISLT) as a salvage procedure to overcome inadequate gain of FLRV after PVE. Methods In eight patients, FLRV was further pre-conditioned following failed PVE prior to hepatectomy (ISLT-group). We compared FLRV changes in the ISLT group with patients receiving extended right hepatectomy following sufficient PVE (PVEres-group). Survival of the ISLT-group was compared to PVEres patients and PVE patients with insufficient FLRV gain or tumor progress who did not receive further surgery (PVEnores-group). Results Patient characteristics and surgical outcome were comparable in both groups. The mean FLRV-to-body-weight ratio in the ISLT group was smaller than in the PVEres-group pre- and post-PVE. One intraoperative mortality due to a coronary infarction was observed for an ISLT patient. ISLT was successfully completed in the remaining seven ISLT patients. Liver function and 2-year survival of ~ 50% was comparable to patients with extended right hepatectomy after efficient PVE. Patients who received a PVE but who were not subsequently resected (PVEnores) demonstrated no survival beyond 4 months. Conclusion Despite extended embolization of segments I and IV-VIII, ISLT should be considered if hypertrophy was not adequate. Liver function and overall survival after ISLT was comparable to patients with trisectionectomy after efficient PVE.
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Lehwald-Tywuschik, Nadja; Vaghiri, Sascha; Schulte am Esch, Jan; Alaghmand, Salman; Klosterkemper, Yan; Schimmöller, Lars; et al. (2020). In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.4929936.v1
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AUTHORS (12)
NL
Nadja Lehwald-Tywuschik
SV
Sascha Vaghiri
JS
Jan Schulte am Esch
SA
Salman Alaghmand
YK
Yan Klosterkemper
LS
Lars Schimmöller
AL
Anja Lachenmayer
HA
Hany Ashmawy
AK
Andreas Krieg
ST
Stefan A. Topp
AR
Alexander Rehders
WK
Wolfram Trudo Knoefel