Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands.
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands.
Surgery. 2019 Apr;165(4):686-695. doi: 10.1016/j.surg.2018.11.004. Epub 2018 Dec 17.
Patients considered for liver resection with insufficient volume or function of the future remnant liver are candidates for portal vein embolization to allow safe resection. The aim of this study is to analyze the volumetric and functional responses after portal vein embolization and to evaluate predictors of the hypertrophy response.
All patients who underwent portal vein embolization before liver resection 2006-2017 were included. Patients who did not undergo computed tomography-volumetry and functional assessment with technetium-99m mebrofenin hepatobiliary scintigraphy before and after portal vein embolization were excluded. The functional and volumetric response rates were calculated. Multiple regression analysis was conducted to examine the relationship between the hypertrophy response and potential predictors.
A total of 90 patients underwent portal vein embolization of the right liver. After 3 weeks, there was a significant increase in both volumetric and functional share of the future remnant liver (both P < .01). The increase in functional share exceeded the increase in volumetric share (P < .01). The median functional contribution of segment 4 after portal vein embolization was 41.5% (31.7%-48.7%) of the nonembolized lobe. Preoperative chemotherapy was not a significant predictor of the increase in function or volume. Compared with benign lesions, malignant diseases were significant negative predictors of the functional response.
A total of 3 weeks after portal vein embolization, the functional response exceeded that of the volumetric response, meaning that the waiting time to resection potentially can be decreased. Segment 4 had a significant share of both volume and function, enabling surgical strategies only leaving segment 4 as a monosegment. Neoadjuvant chemotherapy had no negative influence on the hypertrophy response.
对于未来剩余肝脏体积或功能不足而考虑进行肝切除术的患者，门静脉栓塞术是安全切除的候选方法。本研究旨在分析门静脉栓塞术后的体积和功能反应，并评估肥大反应的预测因素。
所有 2006-2017 年接受肝切除术前行门静脉栓塞术的患者均纳入本研究。排除未行 CT 容积测量和门静脉栓塞术前后锝-99m 美罗芬尼肝胆闪烁显像术进行功能评估的患者。计算功能和体积反应率。采用多元回归分析检查肥大反应与潜在预测因素之间的关系。
共 90 例患者接受了右肝门静脉栓塞术。3 周后，未来剩余肝脏的体积和功能比例均显著增加（均 P <.01）。功能比例的增加超过了体积比例的增加（P <.01）。门静脉栓塞术后，4 段的功能贡献中位数为非栓塞叶的 41.5%（31.7%-48.7%）。术前化疗不是功能或体积增加的显著预测因素。与良性病变相比，恶性疾病是功能反应的显著负预测因素。
门静脉栓塞术后 3 周，功能反应超过体积反应，这意味着潜在的切除等待时间可以缩短。4 段在体积和功能上均有显著的比例，使得手术策略仅留下 4 段作为单段。新辅助化疗对肥大反应没有负面影响。
