title: Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function.
abstract: OBJECTIVE
  The aim of this study was to assess the safety and efficacy of extended liver venous deprivation (eLVD), i.e. combination of right portal vein embolisation and right (accessory right) and middle hepatic vein embolisation before major hepatectomy for future remnant liver (FRL) functional increase.
  
  
  METHODS
  eLVD was performed in non-cirrhotic patients referred for major hepatectomy in a context of small FRL (baseline FRL <25% of the total liver volume or FRL function <2.69%/min/m2). All patients underwent99mTc-mebrofenin hepatobiliary scintigraphy (HBS) and computed tomographic evaluations.
  
  
  RESULTS
  Ten consecutive patients underwent eLVD before surgery for liver metastases (n = 8), Klatskin tumour (n = 1) and gallbladder carcinoma (n = 1). FRL function increased by 64.3% (range = 28.1-107.5%) at day 21. In patients with serial measurements, maximum FRL function was at day 7 (+65.7 ± 16%). The FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day). Thirty-one days (range = 22-45 days) after eLVD, 9/10 patients were resected. No post-hepatectomy liver failure was reported. Two grade II and one grade III complications (Dindo-Clavien classification) occurred. No patient died with-in 90 days following surgery.
  
  
  CONCLUSIONS
  eLVD is safe and provides a marked and very rapid increase in liver function, unprecedented for an interventional radiology procedure.
  
  
  CONCLUSIONS
  • eLVD is safe • eLVD provides a marked and very rapid increase in liver function • After eLVD, the FRL-F increased by 64.3% (28.1-107.5%) at day 21 • After eLVD, the maximum FRL-F was obtained at day 7 (+65.7 ± 16%) • After eLVD, the FRL volume increased by +53.4% at 7 days (+25 ± 8 cc/day).
authors.affiliation: Department of Radiology, St-Eloi University Hospital, 34980, Montpellier, France. B-guiu@chu-montpellier.fr.|INSERM U1194, Montpellier Cancer Research Institute, 34298, Montpellier, France. B-guiu@chu-montpellier.fr.|Department of Radiology, St-Eloi University Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France. B-guiu@chu-montpellier.fr.
authors.forename: Boris
authors.initials: B
authors.lastname: Guiu
authors.affiliation: Department of Surgery, Institut du Cancer de Montpellier (ICM), 34298, Montpellier, France.
authors.forename: François
authors.initials: F
authors.lastname: Quenet
authors.affiliation: Department of Radiology, St-Eloi University Hospital, 34980, Montpellier, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Escal
authors.affiliation: Department of Pathology, Institut du Cancer de Montpellier (ICM), 34298, Montpellier, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bibeau
authors.affiliation: Department of Radiology, St-Eloi University Hospital, 34980, Montpellier, France.
authors.forename: Lauranne
authors.initials: L
authors.lastname: Piron
authors.affiliation: Department of Surgery, Institut du Cancer de Montpellier (ICM), 34298, Montpellier, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rouanet
authors.affiliation: Department of Surgery, St-Eloi University Hospital, 34295, Montpellier, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Fabre
authors.affiliation: Department of Surgery, Beausoleil Clinic, 34980, Montpellier, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Jacquet
authors.affiliation: Department of Radiology, CHUV, Lausanne, Switzerland.
authors.forename: Alban
authors.initials: A
authors.lastname: Denys
authors.affiliation: INSERM U1194, Montpellier Cancer Research Institute, 34298, Montpellier, France.|Department of Nuclear Medicine, Institut du Cancer de Montpellier (ICM), 34298, Montpellier, France.
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Kotzki
authors.affiliation: Department of Anesthesiology, St-Eloi University Hospital, 34980, Montpellier, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Verzilli
authors.affiliation: INSERM U1194, Montpellier Cancer Research Institute, 34298, Montpellier, France.|Department of Nuclear Medicine, Institut du Cancer de Montpellier (ICM), 34298, Montpellier, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Deshayes
mesh_terms: D000368:Aged; D000814:Aniline Compounds; D001650:Bile Duct Neoplasms / Q000601:surgery; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000601:surgery; D005998:Glycine; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006503:Hepatic Veins; D006801:Humans; D007098:Imino Acids; D018285:Klatskin Tumor / Q000601:surgery; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017093:Liver Failure / Q000209:etiology / Q000517:prevention & control; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011169:Portal Vein; D011300:Preoperative Care / Q000379:methods; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods; D014057:Tomography, X-Ray Computed
chemical_list: D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine
keywords: Hepatic vein; Liver; Portal vein embolisation; Scintigraphy; Surgery