Improving the Safety of Major Resection for Hepatobiliary Malignancy: Portal Vein Embolization and Recent Innovations in Liver Regeneration Strategies

David C. Madoff, Bruno C. Odisio, Erik Schadde, Ron C. Gaba, Roelof J. Bennink, Thomas M. van Gulik, Boris Guiu

Research output: Contribution to journalReview articleAcademicpeer-review

27 Citations (Scopus)

Abstract

Purpose of review: For three decades, portal vein embolization (PVE) has been the “gold-standard” strategy to hypertrophy the anticipated future liver remnant (FLR) in advance of major hepatectomy. During this time, CT volumetry was the most common method to preoperatively assess FLR quality and function and used to determine which patients are appropriate surgical candidates. This review provides the most up-to-date methods for preoperatively assessing the anticipated FLR and summarizes data from the currently available strategies used to induce FLR hypertrophy before surgery for hepatobiliary malignancy. Recent findings: Functional and physiological imaging is increasingly replacing standard CT volumetry as the method of choice for preoperative FLR assessment. PVE, associating liver partition and portal vein ligation, radiation lobectomy, and liver venous deprivation are all currently available techniques to hypertrophy the FLR. Each strategy has pros and cons based on tumor type, extent of resection, presence or absence of underlying liver disease, age, performance status, complication rates, and other factors. Summary: Numerous strategies can lead to FLR hypertrophy and improve the safety of major hepatectomy. Which is best has yet to be determined.
Original languageEnglish
Article number59
JournalCurrent oncology reports
Volume22
Issue number6
DOIs
Publication statusPublished - 1 Jun 2020

Keywords

  • ALPPS
  • Future liver remnant
  • Hepatic regeneration
  • Liver venous deprivation
  • Portal vein embolization
  • Radiation lobectomy

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