Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
Eur Radiol. 2020 Jul;30(7):3862-3868. doi: 10.1007/s00330-020-06746-4. Epub 2020 Mar 7.
To assess the effect of salvage hepatic vein embolization (HVE) on the volume of the future liver remnant (FLR) for patients with metastatic colorectal cancer (mCRC) and inadequate hypertrophy following initial portal vein embolization (PVE).
From April 2011 to October 2018, 9 patients with mCRC underwent HVE following PVE. The right or middle hepatic vein was embolized with coils and/or vascular plugs. Liver volumes were calculated at baseline, following PVE, and following HVE, in order to assess the hypertrophic effect of PVE and HVE on the FLR.
Nine patients underwent HVE (n = 3, right HVE; n = 6, middle HVE) because of inadequate FLR hypertrophy following PVE. The standardized FLR increased from 0.16 (median, range 0.08-0.24) at baseline to 0.22 (median, range 0.13-0.29) following PVE (p = 0.0005) to 0.26 (median, range 0.19-0.37) following HVE (p = 0.0050). HVE was performed 40 days (median, range 19-128 days) following PVE, and assessment of FLR hypertrophy was performed 41 days (median, range 19-92 days) following HVE. Four of nine patients underwent hepatectomy; 5 patients failed to undergo hepatectomy (n = 3, inadequate hypertrophy; n = 1, disease progression; n = 1, portal hypertension). One patient required repeat HVE due to a patent accessory vein.
Salvage HVE is an effective technique to induce additional FLR hypertrophy in patients with mCRC and inadequate FLR after initial PVE.
• Hepatic vein embolization is effective to induce additional liver hypertrophy in surgical patients with metastatic colorectal carcinoma and inadequate hypertrophy after portal vein embolization. • Increases in future liver remnant volume are feasible in patients who receive hepatotoxic neoadjuvant systemic therapy for metastatic colorectal carcinoma. • Sequential portal vein embolization and hepatic vein embolization can be a viable technique to induce liver hypertrophy in patients with small baseline future liver remnant volumes (< 20%).
评估补救性肝静脉栓塞（HVE）对初始门静脉栓塞（PVE）后转移性结直肠癌（mCRC）患者和肝切除量不足的未来肝（FLR）的影响。
2011 年 4 月至 2018 年 10 月，9 例 mCRC 患者在 PVE 后接受 HVE。使用线圈和/或血管塞栓塞右或中肝静脉。在基线、PVE 后和 HVE 后计算肝体积，以评估 PVE 和 HVE 对 FLR 的增生作用。
9 例患者因 PVE 后 FLR 增生不足而行 HVE（n=3，右 HVE；n=6，中 HVE）。标准化 FLR 从基线时的 0.16（中位数，范围 0.08-0.24）增加到 PVE 后 0.22（中位数，范围 0.13-0.29）（p=0.0005）和 HVE 后 0.26（中位数，范围 0.19-0.37）（p=0.0050）。HVE 在 PVE 后 40 天（中位数，范围 19-128 天）进行，FLR 增生评估在 HVE 后 41 天（中位数，范围 19-92 天）进行。9 例患者中有 4 例接受了肝切除术；5 例患者未能接受肝切除术（n=3，增生不足；n=1，疾病进展；n=1，门静脉高压）。1 例患者因副肝静脉通畅而需要再次 HVE。
补救性 HVE 是一种有效的技术，可诱导初始 PVE 后 mCRC 患者和初始 FLR 不足的额外 FLR 增生。
• 肝静脉栓塞术对接受转移性结直肠癌新辅助系统治疗的肝切除量不足的患者是有效的，可诱导额外的肝增生。• 在接受转移性结直肠癌新辅助系统治疗的患者中，增加未来肝切除量是可行的。• 序贯门静脉栓塞术和肝静脉栓塞术可作为诱导小基线未来肝切除量（<20%）患者肝增生的可行技术。
