27 - Freie Mitteilung
15. Mai 2019, 15:30 - 17:00, Bellavista 2, 6. OG
Initial experience of “Double” portal and hepatic vein occlusion to induce rapid liver hypertrophy – Comparison of two different techniques
F. Heid1, T. Gimenez Maurel2, L. F. Grochola1, S. Breitenstein1, C. A. Binkert1, A. Serrablo2, E. Schadde1, 3, Presenter: F. Heid1 (1Winterthur, 2Zaragoza/ES, 3Chicago/USA)
The combination of the simultaneous occlusion of the portal veins supplying and the hepatic veins draining the liver (DVO) has been shown to induce rapid hypertrophy of the future liver remnant (FLR) in animal studies and pilot human studies. This study compares two different methods of DVO in two different centers.
The records of patients undergoing embolization of both portal and hepatic veins in a Swiss and Spanish center were reviewed. Demographics, indications and liver volume were analyzed by standardized liver remnant volume (sFLR), liver to body mass ratio (LBWR) and clinical outcomes were assessed. Technical difference between the two centers were compared. The primary interest was feasibility of resection.
Between 09/2017–11/2018, the Swiss and the Spanish center performed DVO in 5 and 8 patients, respectively. The Spanish center performed portal vein ligation in a first stage and then hepatic vein embolization by interventional radiology (IR) after an average of 8.9 days, the Swiss center performed simultaneous portal and hepatic vein embolization by IR. Diagnosis was bi-lobar colorectal liver metastasis (CRLM) in 12 patients, and intrahepatic cholangiocarcinoma (IHCC) in one patient. 12/13 patients underwent resection (feasibility 92%). Median age was 54 (IQR 50 - 66) years. sFLR and LBWR were 0.26% and 0.58, respectively, prior to DVO, 0.40% and 0.88 at a median of 20 days afterwards. The kinetic growth rates between the Swiss and the Spanish cohort were comparable (0.13% sFLR/week vs. 0.05% sFLR/week, p=0.14).
Occlusion of portal and hepatic veins can be achieved using different methods to gain comparable volume growth in this small series. This novel technique has to be studied further prospectively and compared to the gold standard of portal vein embolization.