Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy?
<b>Purpose</b>: Among liver hypertrophy technics, liver venous deprivation (LVD) has been recently introduced as an effective procedure to combine simultaneous portal inflow and hepatic outflow abrogation, raising growing clinical interest. The aim of this study is to investigate the rol...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-09-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/17/4363 |
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| author | Rebecca Marino Francesca Ratti Angelo Della Corte Domenico Santangelo Lucrezia Clocchiatti Carla Canevari Patrizia Magnani Federica Pedica Andrea Casadei-Gardini Francesco De Cobelli Luca Aldrighetti |
| author_facet | Rebecca Marino Francesca Ratti Angelo Della Corte Domenico Santangelo Lucrezia Clocchiatti Carla Canevari Patrizia Magnani Federica Pedica Andrea Casadei-Gardini Francesco De Cobelli Luca Aldrighetti |
| author_sort | Rebecca Marino |
| collection | DOAJ |
| description | <b>Purpose</b>: Among liver hypertrophy technics, liver venous deprivation (LVD) has been recently introduced as an effective procedure to combine simultaneous portal inflow and hepatic outflow abrogation, raising growing clinical interest. The aim of this study is to investigate the role of LVD for preoperative optimization of future liver remnant (FLR) in perihilar cholangiocarcinoma (PHC), especially when compared with portal vein embolization (PVE). <b>Methods</b>: Between January 2013 and July 2022, all patients diagnosed with PHC and scheduled for preoperative optimization of FTR, through radiological hypertrophy techniques, prior to liver resection, were included. FTR volumetric assessment was evaluated at two distinct timepoints to track the progression of both early (T<sub>1</sub>, 10 days post-procedural) and late (T<sub>2</sub>, 21 days post-procedural) efficacy indicators. Post-procedural outcomes, including functional and volumetric analyses, were compared between the LVD and the PVE cohorts. <b>Results</b>: A total of 12 patients underwent LVD while 19 underwent PVE. No significant differences in either post-procedural or post-operative complications were found. Post-procedural FLR function, calculated with (99m) Tc-Mebrofenin hepatobiliary scintigraphy, and kinetic growth rate, at both timepoints, were greater in the LVD cohort (3.12 ± 0.55%/min/m<sup>2</sup> vs. 2.46 ± 0.64%/min/m<sup>2</sup>, <i>p</i> = 0.041; 27.32 ± 16.86%/week (T<sub>1</sub>) vs. 15.71 ± 9.82%/week (T<sub>1</sub>) <i>p</i> < 0.001; 17.19 ± 9.88%/week (T<sub>2</sub>) vs. 9.89 ± 14.62%/week (T<sub>2</sub>) <i>p</i> = 0.034) when compared with the PVE cohort. Post-procedural FTR volumes were similar for both hypertrophy techniques. <b>Conclusions</b>: LVD is an effective procedure to effectively optimize FLR before liver resection for PHC. The faster growth rate combined with the improved FLR function, when compared to PVE alone, could maximize surgical outcomes by lowering post-hepatectomy liver failure rates. |
| first_indexed | 2024-03-10T23:26:58Z |
| format | Article |
| id | doaj.art-b2d3038152804e33b6b9294fa674df28 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T23:26:58Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-b2d3038152804e33b6b9294fa674df282023-11-19T07:56:42ZengMDPI AGCancers2072-66942023-09-011517436310.3390/cancers15174363Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy?Rebecca Marino0Francesca Ratti1Angelo Della Corte2Domenico Santangelo3Lucrezia Clocchiatti4Carla Canevari5Patrizia Magnani6Federica Pedica7Andrea Casadei-Gardini8Francesco De Cobelli9Luca Aldrighetti10Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milan, ItalyHepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milan, ItalyDepartment of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, ItalyDepartment of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, ItalyHepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milan, ItalyNuclear Medicine Department, San Raffaele University and Research Hospital, 20132 Milan, ItalyNuclear Medicine Department, San Raffaele University and Research Hospital, 20132 Milan, ItalyPathology Unit, Department of Experimental Oncology, San Raffaele Hospital, 20132 Milan, ItalyDepartment of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milan, ItalyDepartment of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, ItalyDepartment of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, Italy<b>Purpose</b>: Among liver hypertrophy technics, liver venous deprivation (LVD) has been recently introduced as an effective procedure to combine simultaneous portal inflow and hepatic outflow abrogation, raising growing clinical interest. The aim of this study is to investigate the role of LVD for preoperative optimization of future liver remnant (FLR) in perihilar cholangiocarcinoma (PHC), especially when compared with portal vein embolization (PVE). <b>Methods</b>: Between January 2013 and July 2022, all patients diagnosed with PHC and scheduled for preoperative optimization of FTR, through radiological hypertrophy techniques, prior to liver resection, were included. FTR volumetric assessment was evaluated at two distinct timepoints to track the progression of both early (T<sub>1</sub>, 10 days post-procedural) and late (T<sub>2</sub>, 21 days post-procedural) efficacy indicators. Post-procedural outcomes, including functional and volumetric analyses, were compared between the LVD and the PVE cohorts. <b>Results</b>: A total of 12 patients underwent LVD while 19 underwent PVE. No significant differences in either post-procedural or post-operative complications were found. Post-procedural FLR function, calculated with (99m) Tc-Mebrofenin hepatobiliary scintigraphy, and kinetic growth rate, at both timepoints, were greater in the LVD cohort (3.12 ± 0.55%/min/m<sup>2</sup> vs. 2.46 ± 0.64%/min/m<sup>2</sup>, <i>p</i> = 0.041; 27.32 ± 16.86%/week (T<sub>1</sub>) vs. 15.71 ± 9.82%/week (T<sub>1</sub>) <i>p</i> < 0.001; 17.19 ± 9.88%/week (T<sub>2</sub>) vs. 9.89 ± 14.62%/week (T<sub>2</sub>) <i>p</i> = 0.034) when compared with the PVE cohort. Post-procedural FTR volumes were similar for both hypertrophy techniques. <b>Conclusions</b>: LVD is an effective procedure to effectively optimize FLR before liver resection for PHC. The faster growth rate combined with the improved FLR function, when compared to PVE alone, could maximize surgical outcomes by lowering post-hepatectomy liver failure rates.https://www.mdpi.com/2072-6694/15/17/4363PeriHilar cholangiocarcinomaliver hypertrophy techniquesportal vein embolizationliver venous deprivationfunctional outcomesvolumetric outcomes |
| spellingShingle | Rebecca Marino Francesca Ratti Angelo Della Corte Domenico Santangelo Lucrezia Clocchiatti Carla Canevari Patrizia Magnani Federica Pedica Andrea Casadei-Gardini Francesco De Cobelli Luca Aldrighetti Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy? Cancers PeriHilar cholangiocarcinoma liver hypertrophy techniques portal vein embolization liver venous deprivation functional outcomes volumetric outcomes |
| title | Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy? |
| title_full | Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy? |
| title_fullStr | Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy? |
| title_full_unstemmed | Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy? |
| title_short | Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy? |
| title_sort | comparing liver venous deprivation and portal vein embolization for perihilar cholangiocarcinoma is it time to shift the focus to hepatic functional reserve rather than hypertrophy |
| topic | PeriHilar cholangiocarcinoma liver hypertrophy techniques portal vein embolization liver venous deprivation functional outcomes volumetric outcomes |
| url | https://www.mdpi.com/2072-6694/15/17/4363 |
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