title: [Contralateral hepatic hypertrophy following unilateral yttrium-90 radioembolization : Implications for liver surgery].
abstract: BACKGROUND
  Preservation of an adequate future liver remnant (FLR) is the principal limitation to liver surgery in patients with primary or secondary liver malignancies. Hence, methods to increase the volume of the FLR in preparation for liver resection are gaining in importance.
  
  
  OBJECTIVE
  In addition to the traditional methods for induction of FLR hypertrophy, such as portal vein embolization (PVE) or portal vein ligation (PVL) with or without parenchymal dissection (ALPPS, in situ split), radioembolization (RE) using yttrium-90 microspheres also leads to a volume increase of non-embolized liver parenchyma. This review outlines its potential role as an alternative procedure for induction of liver hypertrophy.
  
  
  METHODS
  Synopsis and critical discussion of the available literature on the mechanisms of induction of liver hypertrophy, the advantages and drawbacks of the traditional methods, and current research on volume changes associated with RE as well as their implications for possible clinical use in preparation for liver surgery.
  
  
  RESULTS
  Both PVE and PVL can achieve a substantial contralateral volume gain of up to 70 %. The development of contralateral hypertrophy can be accelerated by dissecting the liver parenchyma along the intended plane of resection in addition to PVL (in situ split). Compared to these methods, RE achieves less contralateral liver hypertrophy; however, this effect should not be disregarded as RE provides effective treatment of ipsilateral liver tumors along with induction of hypertrophy and may be associated with a reduced risk of tumor progression compared to PVE and PVL.
  
  
  CONCLUSIONS
  The available data suggest that RE can complement the armamentarium of methods for induction of FLR hypertrophy in specific situations. Further studies are needed to establish its definitive role for this indication and are in preparation.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland. benjamin.garlipp@med.ovgu.de.
authors.forename: B
authors.initials: B
authors.lastname: Garlipp
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Seidensticker
authors.affiliation: Institut für Pathologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Jechorek
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Ptok
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland.
authors.forename: C J
authors.initials: CJ
authors.lastname: Bruns
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Ricke
mesh_terms: D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D006984:Hypertrophy / Q000473:pathology*; D008099:Liver / Q000473:pathology* / Q000528:radiation effects*; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008863:Microspheres; D020360:Neoadjuvant Therapy; D009929:Organ Size / Q000528:radiation effects; D011832:Radiation Injuries / Q000473:pathology*; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes
keywords: Future liver remnant; In-situ-split; Liver hypertrophy induction; Portal vein embolization; Yttrium-90-radioembolization