Background

To evaluate liver venous deprivation (LVD) outcomes in patients with colorectal liver metastasis (CRLM) heavily pretreated with systemic and hepatic arterial infusion pump (HAIP) chemotherapies that had an anticipated insufficient future liver remnant (FLR) hypertrophy after portal vein embolization (PVE).

Methods

PVE was performed with liquid embolics using a transsplenic or ipsilateral transhepatic approach. Simultaneously and via a trans-jugular approach, the right hepatic vein was embolized with vascular plugs. Liver volumetry was assessed on computed tomography before and 3–6 weeks after LVD.

Results

Twelve consecutive CRLM patients that underwent LVD before right hepatectomy or trisectionectomy were included, all previously treated with systemic chemotherapy for a mean of 11.9 months. Six patients had additional HAIP. After embolization, FLR ratio increased from 28.7% ± 5.9 to 42.2% ± 9.0 (P < 0.01). Mean kinetic growth rate (KGR) was 3.56%/week ± 2.3, with a degree of hypertrophy (DH) of 13.8% ± 7.1. In the HAIP subgroup, mean KGR and DH were respectively 3.58%/week ± 2.8 and 14.3% ± 8.7. No severe complications occurred. Ten patients reached surgery after 39 days ± 7.5.

Conclusion

In heavily pretreated patients, LVD safely stimulated a rapid and effective FLR hypertrophy, with a resultant high rate of resection.

中文翻译：

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经皮肝静脉剥夺：经过大量预处理的转移性结直肠癌患者的结果

背景

评估接受过全身和肝动脉输液泵 (HAIP) 化疗的结直肠肝转移 (CRLM) 患者的肝静脉剥夺 (LVD) 结局，这些患者在门静脉栓塞 (PVE) 后预期未来残肝 (FLR) 肥大不足.

方法

使用经脾或同侧经肝方法使用液体栓塞进行 PVE。同时通过经颈静脉途径，用血管栓栓塞右肝静脉。在 LVD 之前和之后 3-6 周通过计算机断层扫描评估肝脏体积。

结果

包括 12 名在右肝切除术或三段切除术前接受 LVD 的连续 CRLM 患者，所有患者之前均接受过平均 11.9 个月的全身化疗。六名患者有额外的HAIP。栓塞后，FLR比从28.7%±5.9增加到42.2%±9.0（P  <0.01）。平均动力学增长率 (KGR) 为 3.56%/周 ± 2.3，肥大程度 (DH) 为 13.8% ± 7.1。在 HAIP 亚组中，平均 KGR 和 DH 分别为 3.58%/周 ± 2.8 和 14.3% ± 8.7。未发生严重并发症。10 名患者在 39 天 ± 7.5 天后进行了手术。

结论

在经过大量预处理的患者中，LVD 安全地刺激了快速有效的 FLR 肥大，从而实现了高切除率。