TY - JOUR
T1 - Improving the Safety of Major Resection for Hepatobiliary Malignancy: Portal Vein Embolization and Recent Innovations in Liver Regeneration Strategies
AU - Madoff, David C.
AU - Odisio, Bruno C.
AU - Schadde, Erik
AU - Gaba, Ron C.
AU - Bennink, Roelof J.
AU - van Gulik, Thomas M.
AU - Guiu, Boris
PY - 2020/6/1
Y1 - 2020/6/1
N2 - 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.
AB - 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.
KW - ALPPS
KW - Future liver remnant
KW - Hepatic regeneration
KW - Liver venous deprivation
KW - Portal vein embolization
KW - Radiation lobectomy
UR - http://www.scopus.com/inward/record.url?scp=85084786678&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s11912-020-00922-x
DO - https://doi.org/10.1007/s11912-020-00922-x
M3 - Review article
C2 - 32415401
SN - 1523-3790
VL - 22
JO - Current oncology reports
JF - Current oncology reports
IS - 6
M1 - 59
ER -