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.	黃孝倫. ALPPS 術式的演變、方法與爭議. 中國普外基礎與臨床雜志, 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.	李志鵬, 曾兆林. 門靜脈栓塞的臨床應用現狀與進展. 中國普外基礎與臨床雜志, 2014, 21(3): 378-382.
7.	王磊, 徐愛民. 門靜脈栓塞術的理論基礎及臨床應用進展. 癌癥進展, 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, 王宏偉, 李長賢. 肝癌綜合治療的現狀與展望. 中華消化外科雜志, 2018, 17(5): 433-436.
14.	楊鴻國, 胡智明, 張成武, 等. 計劃性肝切除: 選擇門靜脈栓塞還是聯合肝臟分隔和門靜脈結扎的二步肝切除?. 中華肝膽外科雜志, 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.	李華馳, 劉佩, 陳雙倩, 等. 結直腸癌肝轉移肝切除術前門靜脈栓塞臨床療效的 Meta 分析. 中華實驗外科雜志, 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, 文張, 宋經清, 等. 前入路肝切除聯合選擇性肝靜脈阻斷技術在 ALPPS 治療肝右葉巨塊型肝癌中的應用 (附 9 例報道). 中國普外基礎與臨床雜志, 2017, 24(12): 1444-1449.
19.	李斌, 姜小清. 在計劃性肝切除的理念下審視聯合肝臟分隔和門靜脈結扎的二步肝切除術及門靜脈栓塞. 臨床外科雜志, 2017, 25(6): 414-416.
20.	劉允怡, 劉曉欣. 對" 聯合肝臟離斷和門靜脈結扎的二步肝切除術”的述評. 中華消化外科雜志, 2013, 12(7): 481-484.
21.	彭馳涵, 李川, 文天夫, 等. 原發性肝癌行 ALPPS 的適應證與禁忌證初探 (附 15 例報道). 中國普外基礎與臨床雜志, 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. 黃孝倫. ALPPS 術式的演變、方法與爭議. 中國普外基礎與臨床雜志, 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. 李志鵬, 曾兆林. 門靜脈栓塞的臨床應用現狀與進展. 中國普外基礎與臨床雜志, 2014, 21(3): 378-382.
7. 王磊, 徐愛民. 門靜脈栓塞術的理論基礎及臨床應用進展. 癌癥進展, 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, 王宏偉, 李長賢. 肝癌綜合治療的現狀與展望. 中華消化外科雜志, 2018, 17(5): 433-436.
14. 楊鴻國, 胡智明, 張成武, 等. 計劃性肝切除: 選擇門靜脈栓塞還是聯合肝臟分隔和門靜脈結扎的二步肝切除?. 中華肝膽外科雜志, 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. 李華馳, 劉佩, 陳雙倩, 等. 結直腸癌肝轉移肝切除術前門靜脈栓塞臨床療效的 Meta 分析. 中華實驗外科雜志, 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, 文張, 宋經清, 等. 前入路肝切除聯合選擇性肝靜脈阻斷技術在 ALPPS 治療肝右葉巨塊型肝癌中的應用 (附 9 例報道). 中國普外基礎與臨床雜志, 2017, 24(12): 1444-1449.
19. 李斌, 姜小清. 在計劃性肝切除的理念下審視聯合肝臟分隔和門靜脈結扎的二步肝切除術及門靜脈栓塞. 臨床外科雜志, 2017, 25(6): 414-416.
20. 劉允怡, 劉曉欣. 對" 聯合肝臟離斷和門靜脈結扎的二步肝切除術”的述評. 中華消化外科雜志, 2013, 12(7): 481-484.
21. 彭馳涵, 李川, 文天夫, 等. 原發性肝癌行 ALPPS 的適應證與禁忌證初探 (附 15 例報道). 中國普外基礎與臨床雜志, 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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