title: Associating portal embolization and artery ligation to induce rapid liver regeneration in staged hepatectomy.
abstract: BACKGROUND
  Insufficient volume of the future liver remnant (FLR) is a major cause of unresectability in patients with bilobar colorectal liver metastases (CLM). The objective of this study was to evaluate the safety and efficacy of the novel associating portal embolization and artery ligation (APEAL) technique before extended right hepatectomy during a two-stage procedure for CLM.
  
  
  METHODS
  All patients who had undergone extended right hepatectomy during two-stage surgery for CLM between 2012 and 2014 were identified retrospectively from a prospectively maintained database. In the first stage, right portal vein embolization, partial right hepatic artery ligation and devascularization of segment IVb along the round ligament without parenchymal transection were associated with clearance of the FLR and/or primary tumour resection. Liver volumetry was performed using OsiriX software on postoperative day (POD) 7 and 30.
  
  
  RESULTS
  Ten patients underwent the APEAL procedure. During the first stage, APEAL was combined with colorectal resection in seven patients. The median (range) interval between the two stages was 45 (31-71) days. The FLR volume increased from 327 (214-537) cm(3) before surgery to 590 (508-1072) cm(3) on POD 7 and 701 (512-1018) cm(3) on POD 30. This corresponded to a FLR regeneration rate of 104 (42-185) and 134 (53-171) per cent respectively. There were no deaths. The overall morbidity rate was 60 per cent (6 of 10) after each procedure, with severe morbidity occurring in two and three of ten patients after the first and second procedures respectively.
  
  
  CONCLUSIONS
  APEAL induces fast, safe, reproducible and effective FLR growth when an extended right hepatectomy is scheduled in patients with multiple bilobar CLM.
authors.affiliation: Department of Surgical Oncology, Léon Bérard Cancer Centre, Lyon, France.|Institut National de la Santé et de la Recherche Médicale, U1032, LabTau, Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Dupré
authors.affiliation: Department of Surgical Oncology, Léon Bérard Cancer Centre, Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Hitier
authors.affiliation: Department of Surgical Oncology, Léon Bérard Cancer Centre, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Peyrat
authors.affiliation: Department of Surgical Oncology, Léon Bérard Cancer Centre, Lyon, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Surgical Oncology, Léon Bérard Cancer Centre, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Meeus
authors.affiliation: Department of Surgical Oncology, Léon Bérard Cancer Centre, Lyon, France.|Institut National de la Santé et de la Recherche Médicale, U1032, LabTau, Lyon, France.|Université de Lyon, Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Rivoire
mesh_terms: D000328:Adult; D000368:Aged; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008113:Liver Neoplasms / Q000175:diagnosis / Q000628:therapy*; D008115:Liver Regeneration; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*