Purpose of review

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.

Recent findings

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.

Summary

Numerous strategies can lead to FLR hypertrophy and improve the safety of major hepatectomy. Which is best has yet to be determined.

中文翻译：

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提高肝胆恶性肿瘤主要切除术的安全性：门静脉栓塞术和肝脏再生策略的最新创新。

审查目的

三十年来，门静脉栓塞术 (PVE) 一直是主要肝切除术之前使预期的未来残余肝 (FLR) 肥大的“金标准”策略。在此期间，CT 容积测量是术前评估 FLR 质量和功能并用于确定哪些患者适合手术的最常用方法。本综述提供了术前评估预期 FLR 的最新方法，并总结了目前用于在肝胆恶性肿瘤手术前诱导 FLR 肥大的现有策略的数据。

最近的发现

功能和生理成像越来越多地取代标准 CT 体积测量，成为术前 FLR 评估的首选方法。PVE、相关肝分区和门静脉结扎术、放射性肺叶切除术和肝静脉剥夺都是目前可用的使 FLR 肥大的技术。根据肿瘤类型、切除范围、是否存在潜在肝病、年龄、体能状态、并发症发生率和其他因素，每种策略都有优缺点。

概括

许多策略可导致 FLR 肥大并提高主要肝切除术的安全性。哪个最好尚未确定。