Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA.
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Curr Oncol Rep. 2020 May 16;22(6):59. doi: 10.1007/s11912-020-00922-x.
For three decades, portal vein embolization (PVE) has been the "gold-standard" strategy to hypertrophy the anticipated future liver remnant (FLR) in advance of major hepatectomy. During this time, CT volumetry was the most common method to preoperatively assess FLR quality and function and used to determine which patients are appropriate surgical candidates. This review provides the most up-to-date methods for preoperatively assessing the anticipated FLR and summarizes data from the currently available strategies used to induce FLR hypertrophy before surgery for hepatobiliary malignancy.
Functional and physiological imaging is increasingly replacing standard CT volumetry as the method of choice for preoperative FLR assessment. PVE, associating liver partition and portal vein ligation, radiation lobectomy, and liver venous deprivation are all currently available techniques to hypertrophy the FLR. Each strategy has pros and cons based on tumor type, extent of resection, presence or absence of underlying liver disease, age, performance status, complication rates, and other factors. Numerous strategies can lead to FLR hypertrophy and improve the safety of major hepatectomy. Which is best has yet to be determined.
三十年来，门静脉栓塞术（PVE）一直是在进行大肝切除术前使预期未来肝残留量（FLR）增生的“金标准”策略。在此期间，CT 体积测量是最常用的术前评估 FLR 质量和功能的方法，并用于确定哪些患者适合手术。本综述提供了最新的方法来术前评估预期的 FLR，并总结了目前用于肝胆恶性肿瘤术前诱导 FLR 增生的可用策略的数据。
功能和生理成像正逐渐取代标准 CT 体积测量，成为术前 FLR 评估的首选方法。PVE、联合肝脏分割和门静脉结扎、放射叶切除术和肝静脉剥夺都是目前可用于使 FLR 增生的技术。每种策略都基于肿瘤类型、切除范围、是否存在潜在的肝脏疾病、年龄、身体状况、并发症发生率和其他因素而具有优缺点。许多策略可以导致 FLR 增生并提高大肝切除术的安全性。哪种方法最好尚未确定。
