Application of liver venous deprivation before two-stage radical hepatectomy in liver cancer patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Chang ¹ , ZHANG Xiaoyun ¹ , JIN Chen ¹ , YANG Jiayin ¹ , WU Hong ¹ , WANG Wentao ¹ , LU Qiang ² , LI Wei ³ , JIAO He ³ , YAN Lünan ¹ ,  WEN Tianfu ¹ ,  LU Wusheng ¹

1. Department of Liver Surgery/Liver Transplantation Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. Department of Interventional Radiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WEN Tianfu, Email: tianfu1962@163.com; LU Wusheng, Email: luwu8@126.com

Keywords：

liver cancer; liver venous deprivation; two-stage hepatectomy; portal vein embolization; hepatic vein embolization

DOI：

10.7507/1007-9424.201906029

Video：

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Objective To explore the application of the technique of liver venous deprivation (LVD) for two-stage radical hepatectomy in patient with liver cancer underlying hepatitis B virus infection.Methods A 53 years old patient diagnosed with central primary liver cancer (Ⅴ/Ⅷ segment) could not receive standard right hepatectomy since his future liver remnant was insufficient, so the LVD was performed to induce FLR growth. The general condition and CT scan were repeated at 1-, 2- and 3-week after LVD, the FLR and FLR weigh/ body weight ratio were calculated.Results The FLR and FLR weight/body weight ratio before LVD were 24.2% and 0.459%, the FLR at 1-, 2- and 3-week after LVD were 29.5%, 38.3% and 44.4% respectively, the FLR weight/body weight were 0.545%, 0.707% and 0.820% at 1-, 2- and 3-week after LVD. The standard right hepatectomy was undertaken successfully at 25 days after LVD and discharged safely.Conclusion The LVD technique could induce a rapid and large FLR volume and offer opportunity for patients with insufficient FLR to receive two-stage radical hepatectomy, is a novel method to induce FLR growth effectively.

Citation： LIU Chang, ZHANG Xiaoyun, JIN Chen, YANG Jiayin, WU Hong, WANG Wentao, LU Qiang, LI Wei, JIAO He, YAN Lünan, WEN Tianfu, LU Wusheng. Application of liver venous deprivation before two-stage radical hepatectomy in liver cancer patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(7): 841-846. doi: 10.7507/1007-9424.201906029 Copy

1.	Torre LA, Siegel RL, Ward EM, et al. Global cancer incidence and mortality rates and trends—an update. Cancer Epidemiol Biomarkers Prev, 2016, 25(1): 16-27.
2.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
3.	van Gulik TM, van den Esschert JW, de Graaf W, et al. Controversies in the use of portal vein embolization. Dig Surg, 2009, 25(6): 436-444.
4.	黄孝伦. ALPPS 术式的演变、方法与争议. 中国普外基础与临床杂志, 2016, 23(1): 5-8.
5.	Bertens KA, Hawel J, Lung K, et al. ALPPS: challenging the concept of unresectability—a systematic review. Int J Surg, 2015, 13: 280-287.
6.	李志鹏, 曾兆林. 门静脉栓塞的临床应用现状与进展. 中国普外基础与临床杂志, 2014, 21(3): 378-382.
7.	王磊, 徐爱民. 门静脉栓塞术的理论基础及临床应用进展. 癌症进展, 2013, 11(3): 207-211.
8.	Guiu B, Chevallier P, Denys A, et al. Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol, 2016, 26(12): 4259-4267.
9.	Hwang S, Ha TY, Ko GY, et al. Preoperative sequential portal and hepatic vein embolization in patients with hepatobiliary malignancy. World J Surg, 2015, 39(12): 2990-2998.
10.	Munene G, Parker RD, Larrigan J, et al. Sequential preoperative hepatic vein embolization after portal vein embolization for extended left hepatectomy in colorectal liver metastases. World J Surg Oncol, 2013, 11: 134.
11.	Ma KW, Cheung TT. Surgical resection of localized hepatocellular carcinoma: patient selection and special consideration. J Hepatocell Carcinoma, 2016, 4: 1-9.
12.	Liu C, Duan LG, Lu WS, et al. Prognosis evaluation in patients with hepatocellular carcinoma after hepatectomy: comparison of BCLC, TNM and Hangzhou criteria staging systems. PLoS One, 2014, 9(8): e103228.
13.	李相成, 王宏伟, 李长贤. 肝癌综合治疗的现状与展望. 中华消化外科杂志, 2018, 17(5): 433-436.
14.	杨鸿国, 胡智明, 张成武, 等. 计划性肝切除: 选择门静脉栓塞还是联合肝脏分隔和门静脉结扎的二步肝切除?. 中华肝胆外科杂志, 2018, 24(8): 565-568.
15.	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(5): 521-527.
16.	李华驰, 刘佩, 陈双倩, 等. 结直肠癌肝转移肝切除术前门静脉栓塞临床疗效的 Meta 分析. 中华实验外科杂志, 2015, 32(6): 1418-1420.
17.	Schnitzbauer AA, Lang SA, Lang H, et al. Reply to letter: "The ALPPS procedure for extended indications in liver surgery: an old finding applied in surgical oncology". Ann Surg, 2013, 257(6): e27.
18.	徐邦浩, 文张, 宋经清, 等. 前入路肝切除联合选择性肝静脉阻断技术在 ALPPS 治疗肝右叶巨块型肝癌中的应用 (附 9 例报道). 中国普外基础与临床杂志, 2017, 24(12): 1444-1449.
19.	李斌, 姜小清. 在计划性肝切除的理念下审视联合肝脏分隔和门静脉结扎的二步肝切除术及门静脉栓塞. 临床外科杂志, 2017, 25(6): 414-416.
20.	刘允怡, 刘晓欣. 对" 联合肝脏离断和门静脉结扎的二步肝切除术”的述评. 中华消化外科杂志, 2013, 12(7): 481-484.
21.	彭驰涵, 李川, 文天夫, 等. 原发性肝癌行 ALPPS 的适应证与禁忌证初探 (附 15 例报道). 中国普外基础与临床杂志, 2015, 22(10): 1183-1186.
22.	Hwang S, Lee SG, Ko GY, et al. Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg, 2009, 249(4): 608-616.
23.	Guiu B, Quenet F, Escal L, et al. Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function. Eur Radiol, 2017, 27(8): 3343-3352.
24.	Guiu B, Bize P, Gunthern D, et al. Portal vein embolization before right hepatectomy: improved results using n-butyl-cyanoacrylate compared to microparticles plus coils. Cardiovasc Intervent Radiol, 2013, 36(5): 1306-1312.
25.	Zhang W, Liu C, Tan Y, et al. Role of liver resection in treating intermediate and advanced stage adolescent and young adult hepatocellular carcinoma patients: A propensity-matching cohort study. Int J Surg, 2018, 54(Pt A): 259-264.

1. Torre LA, Siegel RL, Ward EM, et al. Global cancer incidence and mortality rates and trends—an update. Cancer Epidemiol Biomarkers Prev, 2016, 25(1): 16-27.
2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
3. van Gulik TM, van den Esschert JW, de Graaf W, et al. Controversies in the use of portal vein embolization. Dig Surg, 2009, 25(6): 436-444.
4. 黄孝伦. ALPPS 术式的演变、方法与争议. 中国普外基础与临床杂志, 2016, 23(1): 5-8.
5. Bertens KA, Hawel J, Lung K, et al. ALPPS: challenging the concept of unresectability—a systematic review. Int J Surg, 2015, 13: 280-287.
6. 李志鹏, 曾兆林. 门静脉栓塞的临床应用现状与进展. 中国普外基础与临床杂志, 2014, 21(3): 378-382.
7. 王磊, 徐爱民. 门静脉栓塞术的理论基础及临床应用进展. 癌症进展, 2013, 11(3): 207-211.
8. Guiu B, Chevallier P, Denys A, et al. Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol, 2016, 26(12): 4259-4267.
9. Hwang S, Ha TY, Ko GY, et al. Preoperative sequential portal and hepatic vein embolization in patients with hepatobiliary malignancy. World J Surg, 2015, 39(12): 2990-2998.
10. Munene G, Parker RD, Larrigan J, et al. Sequential preoperative hepatic vein embolization after portal vein embolization for extended left hepatectomy in colorectal liver metastases. World J Surg Oncol, 2013, 11: 134.
11. Ma KW, Cheung TT. Surgical resection of localized hepatocellular carcinoma: patient selection and special consideration. J Hepatocell Carcinoma, 2016, 4: 1-9.
12. Liu C, Duan LG, Lu WS, et al. Prognosis evaluation in patients with hepatocellular carcinoma after hepatectomy: comparison of BCLC, TNM and Hangzhou criteria staging systems. PLoS One, 2014, 9(8): e103228.
13. 李相成, 王宏伟, 李长贤. 肝癌综合治疗的现状与展望. 中华消化外科杂志, 2018, 17(5): 433-436.
14. 杨鸿国, 胡智明, 张成武, 等. 计划性肝切除: 选择门静脉栓塞还是联合肝脏分隔和门静脉结扎的二步肝切除?. 中华肝胆外科杂志, 2018, 24(8): 565-568.
15. 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(5): 521-527.
16. 李华驰, 刘佩, 陈双倩, 等. 结直肠癌肝转移肝切除术前门静脉栓塞临床疗效的 Meta 分析. 中华实验外科杂志, 2015, 32(6): 1418-1420.
17. Schnitzbauer AA, Lang SA, Lang H, et al. Reply to letter: "The ALPPS procedure for extended indications in liver surgery: an old finding applied in surgical oncology". Ann Surg, 2013, 257(6): e27.
18. 徐邦浩, 文张, 宋经清, 等. 前入路肝切除联合选择性肝静脉阻断技术在 ALPPS 治疗肝右叶巨块型肝癌中的应用 (附 9 例报道). 中国普外基础与临床杂志, 2017, 24(12): 1444-1449.
19. 李斌, 姜小清. 在计划性肝切除的理念下审视联合肝脏分隔和门静脉结扎的二步肝切除术及门静脉栓塞. 临床外科杂志, 2017, 25(6): 414-416.
20. 刘允怡, 刘晓欣. 对" 联合肝脏离断和门静脉结扎的二步肝切除术”的述评. 中华消化外科杂志, 2013, 12(7): 481-484.
21. 彭驰涵, 李川, 文天夫, 等. 原发性肝癌行 ALPPS 的适应证与禁忌证初探 (附 15 例报道). 中国普外基础与临床杂志, 2015, 22(10): 1183-1186.
22. Hwang S, Lee SG, Ko GY, et al. Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg, 2009, 249(4): 608-616.
23. Guiu B, Quenet F, Escal L, et al. Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function. Eur Radiol, 2017, 27(8): 3343-3352.
24. Guiu B, Bize P, Gunthern D, et al. Portal vein embolization before right hepatectomy: improved results using n-butyl-cyanoacrylate compared to microparticles plus coils. Cardiovasc Intervent Radiol, 2013, 36(5): 1306-1312.
25. Zhang W, Liu C, Tan Y, et al. Role of liver resection in treating intermediate and advanced stage adolescent and young adult hepatocellular carcinoma patients: A propensity-matching cohort study. Int J Surg, 2018, 54(Pt A): 259-264.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of liver venous deprivation before two-stage radical hepatectomy in liver cancer patients

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