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Zentralbl Chir 2013; 138(4): 442-448
DOI: 10.1055/s-0032-1328350
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Pfortaderembolisation zur Konditionierung erweiterter Leberresektionen – aktueller Stand und Ausblick[*]

Portal Vein Embolisation Prior to Extended Liver Resection – Current and Future Aspects
F. Rauchfuss
1   Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Deutschland
,
H. Scheuerlein
1   Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Deutschland
,
E. Lopatta
2   Institut für diagnostische und interventionelle Radiologie II, Universitätsklinikum Jena, Jena, Deutschland
,
Y. Dittmar
1   Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Deutschland
,
S. Schüle
1   Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Deutschland
,
U. Settmacher
1   Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
15 August 2013 (online)

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Zusammenfassung

Erweiterte Leberresektionen gehen mit dem Risiko einer postoperativen Leberdysfunktion bis hin zum Leberversagen einher. Im Rahmen multimodaler Therapiekonzepte werden Patienten vor einer erweiterten Leberresektion deshalb konditioniert. Dieses Konzept beinhaltet die Durchführung einer sogenannten Pfortaderembolisation, die zum Ziel hat, das postoperativ in situ verbleibende Lebergewebe zum Wachstum anzuregen und somit das Risiko einer postoperativen Leberdysfunktion zu minimieren. Die vorliegende Arbeit fasst den aktuellen Stand dieser Intervention als Konditionierungsmaßnahme vor erweiterten Leberresektionen zusammen.

Abstract

Extended liver resections are associated with the risk of postoperative liver dysfunction up to liver failure. For this reason, prior to extended liver resections patients are conditioned in multi-modal therapy regimes. Portal vein embolisation is an essential part of such a multi-modal therapy. The aim of this intervention is an induction of hypertrophy of the future remnant liver volume. Thereby, the risk of postoperative liver failure is decreased. This article summarises the actual aspects of portal vein embolisation prior to extended liver resections.

Schlüsselwörter

Leberchirurgie - Leberresektion - Leberversagen - Pfortaderembolisation - zweizeitige Leberresektion

Key words

liver surgery - liver resection - liver failure - portal vein embolisation - two-stage liver resection

* Prof. Dr. Dr. H. Lippert gewidmet


 

  • Literatur

  • 1 Heise M, Jandt K, Rauchfuss F et al. [Management of complications after liver resection]. Zentralbl Chir 2010; 135: 112-120
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Suda K, Ohtsuka M, Ambiru S et al. Risk factors of liver dysfunction after extended hepatic resection in biliary tract malignancies. Am J Surg 2009; 197: 752-758
    CrossrefPubMedSearch in Google Scholar
  • 3 Truant S, Oberlin O, Sergent G et al. Remnant liver volume to body weight ratio > or = 0.5 %: A new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg 2007; 204: 22-33
    CrossrefPubMedSearch in Google Scholar
  • 4 Rous P, Larimore LD. Relation of the portal blood to liver maintenance: a demonstration of liver atrophy conditional on compensation. J Exp Med 1920; 31: 609-632
    CrossrefPubMedSearch in Google Scholar
  • 5 Bax HR, Mansens BJ, Schalm L. Atrophy of the liver after occlusion of the bile ducts or portal vein and compensatory hypertrophy of the unoccluded portion and its clinical importance. Gastroenterology 1956; 31: 131-155
    PubMedSearch in Google Scholar
  • 6 Honjo I, Suzuki T, Ozawa K et al. Ligation of a branch of the portal vein for carcinoma of the liver. Am J Surg 1975; 130: 296-302
    CrossrefPubMedSearch in Google Scholar
  • 7 Kraus GE, Beltran A. Effect of induced infarction on rat liver implanted with Walker carcinoma 256. Arch Surg 1959; 79: 769-774
    CrossrefPubMedSearch in Google Scholar
  • 8 Kinoshita H, Sakai K, Hirohashi K et al. Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg 1986; 10: 803-808
    Search in Google Scholar
  • 9 Makuuchi M, Thai BL, Takayasu K et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990; 107: 521-527
    Search in Google Scholar
  • 10 Di Stefano DR, de Baere T, Denys A et al. Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients. Radiology 2005; 234: 625-630
    CrossrefPubMedSearch in Google Scholar
  • 11 Barbaro B, Caputo F, Tebala C et al. Preoperative right portal vein embolisation: indications and results. Radiol Med 2009; 114: 553-570
    CrossrefPubMedSearch in Google Scholar
  • 12 Liu H, Zhu S. Present status and future perspectives of preoperative portal vein embolization. Am J Surg 2009; 197: 686-690
    CrossrefPubMedSearch in Google Scholar
  • 13 Ferrero A, Vigano L, Polastri R et al. Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg 2007; 31: 1643-1651
    CrossrefPubMedSearch in Google Scholar
  • 14 de Baere T, Denys A, Madoff DC. Preoperative portal vein embolization: indications and technical considerations. Tech Vasc Interv Radiol 2007; 10: 67-78
    CrossrefPubMedSearch in Google Scholar
  • 15 de Baere T, Teriitehau C, Deschamps F et al. Predictive factors for hypertrophy of the future remnant liver after selective portal vein embolization. Ann Surg Oncol 2010; 17: 2081-2089
    CrossrefPubMedSearch in Google Scholar
  • 16 Seyama Y, Kokudo N. Assessment of liver function for safe hepatic resection. Hepatol Res 2009; 39: 107-116
    CrossrefPubMedSearch in Google Scholar
  • 17 Stockmann M, Lock JF, Malinowski M et al. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford) 2010; 12: 139-146
    CrossrefPubMedSearch in Google Scholar
  • 18 Yokoyama Y, Nagino M, Nimura Y. Mechanism of impaired hepatic regeneration in cholestatic liver. J Hepatobiliary Pancreat Surg 2007; 14: 159-166
    CrossrefPubMedSearch in Google Scholar
  • 19 Yokoyama Y, Nagino M, Nimura Y. Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review. World J Surg 2007; 31: 367-374
    CrossrefPubMedSearch in Google Scholar
  • 20 van Lienden KP, van den Esschert JW et al. Portal vein embolization before liver resection: a systematic review. Cardiovasc Intervent Radiol 2013; 36: 25-34
    CrossrefPubMedSearch in Google Scholar
  • 21 Hemming AW, Reed AI, Langham jr. MR et al. Combined resection of the liver and inferior vena cava for hepatic malignancy. Ann Surg 2004; 239: 712-719 discussion 719–721
    CrossrefPubMedSearch in Google Scholar
  • 22 van Gulik TM, van den Esschert JW, de Graaf W et al. Controversies in the use of portal vein embolization. Dig Surg 2008; 25: 436-444
    CrossrefPubMedSearch in Google Scholar
  • 23 Nakano H, Oussoultzoglou E, Rosso E et al. Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy. Ann Surg 2008; 247: 118-124
    CrossrefPubMedSearch in Google Scholar
  • 24 Aussilhou B, Dokmak S, Faivre S et al. Preoperative liver hypertrophy induced by portal flow occlusion before major hepatic resection for colorectal metastases can be impaired by bevacizumab. Ann Surg Oncol 2009; 16: 1553-1559
    CrossrefPubMedSearch in Google Scholar
  • 25 Simoneau E, Aljiffry M, Salman A et al. Portal vein embolization stimulates tumour growth in patients with colorectal cancer liver metastases. HPB (Oxford) 2012; 14: 461-468
    CrossrefPubMedSearch in Google Scholar
  • 26 Zorzi D, Chun YS, Madoff DC et al. Chemotherapy with bevacizumab does not affect liver regeneration after portal vein embolization in the treatment of colorectal liver metastases. Ann Surg Oncol 2008; 15: 2765-2772
    CrossrefPubMedSearch in Google Scholar
  • 27 Lise M, Da Pian PP, Nitti D et al. Colorectal metastases to the liver: present status of management. Dis Colon Rectum 1990; 33: 688-694
    CrossrefPubMedSearch in Google Scholar
  • 28 Chun YS, Vauthey JN, Ribero D et al. Systemic chemotherapy and two-stage hepatectomy for extensive bilateral colorectal liver metastases: perioperative safety and survival. J Gastrointest Surg 2007; 11: 1498-1504 discussion 1504–1495
    CrossrefPubMedSearch in Google Scholar
  • 29 Robles R, Marin C, Lopez-Conesa A et al. Comparative study of right portal vein ligation versus embolisation for induction of hypertrophy in two-stage hepatectomy for multiple bilateral colorectal liver metastases. Eur J Surg Oncol 2012; 38: 586-593
    CrossrefPubMedSearch in Google Scholar
  • 30 de Graaf W, van den Esschert JW, van Lienden KP et al. Induction of tumor growth after preoperative portal vein embolization: is it a real problem?. Ann Surg Oncol 2009; 16: 423-430
    CrossrefPubMedSearch in Google Scholar
  • 31 Hoekstra LT, van Lienden KP, Doets A et al. Tumor progression after preoperative portal vein embolization. Ann Surg 2012; 256: 812-818
    CrossrefPubMedSearch in Google Scholar
  • 32 Abulkhir A, Limongelli P, Healey AJ et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg 2008; 247: 49-57
    CrossrefPubMedSearch in Google Scholar
  • 33 Pamecha V, Levene A, Grillo F et al. Effect of portal vein embolisation on the growth rate of colorectal liver metastases. Br J Cancer 2009; 100: 617-622
    CrossrefPubMedSearch in Google Scholar
  • 34 Rauchfuss F, Lambeck S, Claus RA et al. Sustained liver regeneration after portal vein embolization–a human molecular pilot study. Dig Liver Dis 2012; 44: 681-688
    CrossrefPubMedSearch in Google Scholar
  • 35 Capussotti L, Muratore A, Ferrero A et al. Extension of right portal vein embolization to segment IV portal branches. Arch Surg 2005; 140: 1100-1103
    CrossrefPubMedSearch in Google Scholar
  • 36 Furrer K, Tian Y, Pfammatter T et al. Selective portal vein embolization and ligation trigger different regenerative responses in the rat liver. Hepatology 2008; 47: 1615-1623
    CrossrefPubMedSearch in Google Scholar
  • 37 Libicher M, Herbrik M, Stippel D et al. [Portal vein embolization using the amplatzer vascular plug II: preliminary results]. Rofo 2010; 182: 501-506
    Thieme ConnectPubMedSearch in Google Scholar
  • 38 Lock JF, Reinhold T, Malinowski M et al. The costs of postoperative liver failure and the economic impact of liver function capacity after extended liver resection–a single-center experience. Langenbecks Arch Surg 2009; 394: 1047-1056
    CrossrefPubMedSearch in Google Scholar
  • 39 Hammond JS, Guha IN, Beckingham IJ et al. Prediction, prevention and management of postresection liver failure. Br J Surg 2011; 98: 1188-1200
    CrossrefPubMedSearch in Google Scholar
  • 40 am Esch 2nd JS, Knoefel WT, Klein M et al. Portal application of autologous CD133+ bone marrow cells to the liver: a novel concept to support hepatic regeneration. Stem Cells 2005; 23: 463-470
    CrossrefPubMedSearch in Google Scholar
  • 41 am Esch JS, Schmelzle M, Furst G et al. Infusion of CD133+ bone marrow-derived stem cells after selective portal vein embolization enhances functional hepatic reserves after extended right hepatectomy: a retrospective single-center study. Ann Surg 2012; 255: 79-85
    CrossrefPubMedSearch in Google Scholar
  • 42 Furst G, Schulte am Esch J, Poll LW et al. Portal vein embolization and autologous CD133+ bone marrow stem cells for liver regeneration: initial experience. Radiology 2007; 243: 171-179
    CrossrefPubMedSearch in Google Scholar
  • 43 Knoefel WT, Alexander A, Tustas RY et al. . 2013; 138: 166-172
    PubMedSearch in Google Scholar
  • 44 Hwang S, Lee SG, Ko GY et al. Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg 2009; 249: 608-616
    CrossrefPubMedSearch in Google Scholar
  • 45 Lainas P, Boudechiche L, Osorio A et al. Liver regeneration and recanalization time course following reversible portal vein embolization. J Hepatol 2008; 49: 354-362
    CrossrefPubMedSearch in Google Scholar
  • 46 Schnitzbauer AA, Lang SA, Goessmann H et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 2012; 255: 405-414
    CrossrefPubMedSearch in Google Scholar