Objectives

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).

Methods

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.

Results

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.

Conclusions

Salvage HVE is an effective technique to induce additional FLR hypertrophy in patients with mCRC and inadequate FLR after initial PVE.

Key Points

• 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%).

中文翻译：

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在转移性结直肠癌患者中，门静脉栓塞后的肝静脉栓塞可引起其他肝肥大。

目标

评估挽救性肝静脉栓塞（HVE）对转移性结直肠癌（mCRC）和初始门静脉栓塞（PVE）后肥厚不足的患者未来肝残留量（FLR）的影响。

方法

从2011年4月到2018年10月，有9例mCRC患者在接受PVE后接受了HVE治疗。右或中肝静脉被线圈和/或血管栓塞栓塞。为了评估PVE和HVE对FLR的肥大作用，在基线时，PVE后和HVE后计算肝脏体积。

结果

 由于PVE后FLR肥大不足，九名患者接受了HVE治疗（n  = 3，右HVE；n = 6，中度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（p  = 0.0005）的0.22（中位数，范围0.13-0.29 ）至HVE（p  = 0.0050）的0.26（中位数，范围0.19-0.37 ） 。PVE后40天（中位，介于19-128天）进行HVE，HVE后41天（中位，介于19-92天）进行FLR肥大评估。9名患者中有4名接受了肝切除术；5例患者未进行肝切除术（n  = 3，肥厚不足；n  = 1，疾病进展；n = 1，门脉高压）。一名患者因专利性附属静脉而需要重复进行HVE。

结论

抢救性HVE是一种有效的技术，可在mCRC和初始PVE后FLR不足的患者中诱发其他FLR肥大。

关键点

•肝静脉栓塞可有效治疗转移性结直肠癌且门静脉栓塞后肥大不足的外科手术患者，进一步引起肝脏肥大。

•对于转移性大肠癌接受肝毒性新辅助系统治疗的患者，增加将来的肝残余量是可行的。

•序贯门静脉栓塞和肝静脉栓塞可能是一种可行的技术，可在基线基线肝残余量较小（<20％）的患者中诱发肝脏肥大。