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Huang LM, Zeng ZX, Wu JY, Li YN, Wang JX, Fu YK, Wu JY, Wei SM, Lv JH, Chen WZ, Huang RF, Cheng SQ, Yan ML. Surgical outcomes of hepatocellular carcinoma with extrahepatic bile duct tumor thrombus: a multicenter study. Front Oncol 2023; 13:1291479. [PMID: 38111530 PMCID: PMC10726108 DOI: 10.3389/fonc.2023.1291479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
Background The long-term prognosis after surgery of patients with hepatocellular carcinoma (HCC) and extrahepatic bile duct tumor thrombus (Ex-BDTT) remains unknown. We aimed to identify the surgical outcomes of patients with HCC and Ex-BDTT. Methods A total of 138 patients with Ex-BDTT who underwent hepatectomy with preservation of the extrahepatic bile duct from five large hospitals in China between January 2009 and December 2017 were included. The Cox proportional hazards model was used to analyze overall survival (OS) and recurrence-free survival (RFS). Results With a median follow-up of 60 months (range, 1-127.8 months), the median OS and RFS of the patients were 28.6 and 8.9 months, respectively. The 1-, 3-, and 5-year OS rates of HCC patients with Ex-BDTT were 71.7%, 41.2%, and 33.5%, respectively, and the corresponding RFS rates were 43.5%, 21.7%, and 20.0%, respectively. Multivariate analysis identified that major hepatectomy, R0 resection, and major vascular invasion were independent prognostic factors for OS and RFS. In addition, preoperative serum total bilirubin ≥ 4.2 mg/dL was an independent prognostic factor for RFS. Conclusion Major hepatectomy with preservation of the extrahepatic bile duct can provide favorable long-term survival for HCC patients with Ex-BDTT.
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Affiliation(s)
- Li-Ming Huang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Zhen-Xin Zeng
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Jun-Yi Wu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Yi-Nan Li
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Jin-Xiu Wang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Yang-Kai Fu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Jia-Yi Wu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Shao-Ming Wei
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Provincial Hospital South Branch, Fuzhou, Fujian, China
| | - Jia-Hui Lv
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Wei-Zhao Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Rong-Fa Huang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Shu-Qun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Mao-Lin Yan
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
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2
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Perihilar cholangiocarcinoma: What the radiologist needs to know. Diagn Interv Imaging 2022; 103:288-301. [DOI: 10.1016/j.diii.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
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Gautier S, Chevallier O, Mastier C, d'Athis P, Falvo N, Pilleul F, Midulla M, Rat P, Facy O, Loffroy R. Portal vein embolization with ethylene-vinyl alcohol copolymer for contralateral lobe hypertrophy before liver resection: safety, feasibility and initial experience. Quant Imaging Med Surg 2021; 11:797-809. [PMID: 33532278 DOI: 10.21037/qims-20-808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background To report our preliminary experience with preoperative portal vein embolization (PVE) using liquid ethylene vinyl alcohol (EVOH) copolymer. Methods Retrospectively review of patients with primary or secondary liver malignancies scheduled for extensive hepatectomy after the induction of future liver remnant (FLR) hypertrophy by right or left PVE with EVOH as the only embolic agent between 2014 and 2018 at two academic centers. Cross-sectional imaging liver volumetry data obtained before and 3-6 weeks after PVE were used to assess the FLR volume (FLRV) increase, degree of FLR hypertrophy and the FLR kinetic growth rate (KGR). Results Twenty-six patients (17 males; mean age, 58.7±11 years; range, 32-79 years) were included. The technical and clinical success rate was 100%. PVE produced adequate FLR hypertrophy in all patients. Embolization occurred in all targeted portal branches and in no non-target vessels. The %FLRV increased by 52.9%±32.5% and the degree of FLR hypertrophy was 16.7%±6.8%. The KGR was 4.4%±2.0% per week. Four patients experience minor complications after PVE which resolved with symptomatic treatment. The resection rate was 84.5%. One patient died during surgery for reasons unrelated to PVE. Conclusions Preoperative PVE with EVOH copolymer is feasible, safe, and effective in inducing FLR hypertrophy.
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Affiliation(s)
- Sébastien Gautier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Charles Mastier
- Department of Interventional Radiology and Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Philippe d'Athis
- Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Frank Pilleul
- Department of Interventional Radiology and Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Patrick Rat
- Department of Digestive and Oncologic Surgery, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Facy
- Department of Digestive and Oncologic Surgery, François-Mitterrand University Hospital, Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
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4
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Yim J, Hyun D, Cho SK, Park KB, Park HS, Shin SW, Choi DW, Kim S, Baek SY, Lee SY. Effect of Hyperbilirubinemia on Hepatic Hypertrophy after Portal Vein Embolization and Liver Failure after Hepatectomy in Primary Biliary Malignancy. J Vasc Interv Radiol 2018; 30:31-37. [PMID: 30527653 DOI: 10.1016/j.jvir.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/04/2018] [Accepted: 08/04/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To retrospectively investigate the impact of hyperbilirubinemia on future liver remnant (FLR) volume after percutaneous transhepatic portal vein embolization (PVE) and incidence of post-hepatectomy liver failure in primary biliary malignancy. MATERIALS AND METHODS Eighty-seven patients (62 men, overall mean age 66.9 y) who underwent PVE, using Gelfoam and coils before major hepatectomy between January 2004 and June 2016, were included in this study and divided into a hyperbilirubinemia (serum total bilirubin level at PVE 5.80 ± 2.44 mg/dL; n = 41) group and a control group (1.09 ± 0.73 mg/dL; n = 46). Liver volume was measured from computerized tomographic data before and 18.5 days, on average, after PVE. Correlation between FLR hypertrophy (degree of hypertrophy and percentage increase in future liver remnant [%FLR]) and total bilirubin were analyzed. FLR hypertrophy and incidence of post-hepatectomy liver failure were compared. Simple and multiple regressions were used for univariable and multivariable analyses, respectively. RESULTS Mean FLR volumes before and after PVE were 529.1 cm3 and 640.5 cm3, respectively. Degree of hypertrophy and %FLR were 7.64 ± 4.22 and 21.77 ± 13.34, respectively. There was no significant correlation between FLR hypertrophy and total bilirubin (P > .5). FLR hypertrophy was not significantly different between the 2 groups. Planned major hepatectomy was performed in 73 patients (83.9%). Grade 3 post-hepatectomy liver failure occurred in 6 patients (8.2%; 2 in the hyperbilirubinemia group and 4 in the control group), and its incidence was not significantly different between the groups (P = .354). CONCLUSIONS Hyperbilirubinemia at the time of PVE seems to have no effect on FLR hypertrophy. The incidence of grade 3 post-hepatectomy liver failure is not likely to be influenced, either.
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Affiliation(s)
- Jaehyun Yim
- Department of Radiology, Samsung Medical Center, 81 Irwon-Ro Gangnam-Gu, 06351, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, 81 Irwon-Ro Gangnam-Gu, 06351, Seoul, Korea.
| | - Sung Ki Cho
- Department of Radiology, Samsung Medical Center, 81 Irwon-Ro Gangnam-Gu, 06351, Seoul, Korea
| | - Kwang Bo Park
- Department of Radiology, Samsung Medical Center, 81 Irwon-Ro Gangnam-Gu, 06351, Seoul, Korea
| | - Hong Suk Park
- Department of Radiology, Samsung Medical Center, 81 Irwon-Ro Gangnam-Gu, 06351, Seoul, Korea
| | - Sung Wook Shin
- Department of Radiology, Samsung Medical Center, 81 Irwon-Ro Gangnam-Gu, 06351, Seoul, Korea
| | - Dong Wook Choi
- Department of Surgery, Samsung Medical Center, 81 Irwon-Ro Gangnam-Gu, 06351, Seoul, Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, 81 Irwon-Ro Gangnam-Gu, 06351, Seoul, Korea
| | - Sung-Young Baek
- Statistics and Data Center, Samsung Medical Center, 81 Irwon-Ro Gangnam-Gu, 06351, Seoul, Korea
| | - Sang Yub Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
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Hocquelet A, Sotiriadis C, Duran R, Guiu B, Yamaguchi T, Halkic N, Melloul E, Demartines N, Denys A. Preoperative Portal Vein Embolization Alone with Biliary Drainage Compared to a Combination of Simultaneous Portal Vein, Right Hepatic Vein Embolization and Biliary Drainage in Klatskin Tumor. Cardiovasc Intervent Radiol 2018; 41:1885-1891. [DOI: 10.1007/s00270-018-2075-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/07/2018] [Indexed: 12/28/2022]
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6
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Breguet R, Boudabbous S, Pupulim LF, Becker CD, Rubbia-Brandt L, Toso C, Ronot M, Terraz S. Ethylene vinyl alcohol copolymer for occlusion of specific portal branches during preoperative portal vein embolisation with n-butyl-cyanoacrylate. Eur Radiol 2018; 28:4810-4817. [PMID: 29789913 DOI: 10.1007/s00330-018-5476-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/04/2018] [Accepted: 04/11/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of ethylene vinyl alcohol copolymer (EVOH) injection for selective occlusion of portal branches considered at risk for non-target embolisation during preoperative portal vein embolisation (PVE). METHODS Twenty-nine patients (mean age, 57 ± 17 years) submitted to PVE with n-butyl-cyanoacrylate (NBCA) and additional EVOH for selected portal branches were retrospectively analysed. Indications for the use of EVOH and the selected portal branches were evaluated. Degree of hypertrophy of the future liver remnant (FLR) and kinetic growth were assessed by CT volumetry performed before and 3-6 weeks after PVE. Clinical outcome and histopathological analysis of portal veins occluded with EVOH were reviewed. RESULTS EVOH was indicated intraoperatively for embolisation of selected portal branches that the operator reported at risk to provoke non-target embolisation with NBCA. Indications for the use of EVOH were embolisation of segment IV (n = 21), embolisation of segmental portal branches with early bifurcation (n = 7) and PVE in a 1-year-old girl with cystic hamartomas. All targeted portal branches were successfully embolised. There were no cases with non-target embolisation by EVOH. The degree of hypertrophy of the FLR was 14.3 ± 8.1% and the kinetic growth rate was 2.7 ± 1.8% per week. CONCLUSION EVOH is safe and effective for embolisation of selected portal vein branches considered at risk for non-target embolisation. KEY POINTS • EVOH is another effective liquid embolic agent for preoperative PVE. • EVOH is relatively simple to handle with a minimal risk of non-target embolisation. • During PVE, some portal branches considered complicated to occlude with NBCA may be efficiently embolised with EVOH.
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Affiliation(s)
- Romain Breguet
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland
| | - Sana Boudabbous
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Lawrence F Pupulim
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Christoph D Becker
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland.,Department of Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland.,Department of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Maxime Ronot
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Department of Radiology, University Hospitals of Beaujon, Paris, France
| | - Sylvain Terraz
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. .,Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland.
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7
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Luz JHM, Luz PM, Bilhim T, Martin HS, Gouveia HR, Coimbra É, Gomes FV, Souza RR, Faria IM, de Miranda TN. Portal vein embolization with n-butyl-cyanoacrylate through an ipsilateral approach before major hepatectomy: single center analysis of 50 consecutive patients. Cancer Imaging 2017; 17:25. [PMID: 28931429 PMCID: PMC5607591 DOI: 10.1186/s40644-017-0127-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/12/2017] [Indexed: 02/06/2023] Open
Abstract
Purpose To evaluate the efficacy of portal vein embolization (PVE) with n-Butyl-cyanoacrylate (NBCA) through an ipsilateral approach before major hepatectomy. Secondary end-points were PVE safety, liver resection and patient outcome. Methods Over a 5-year period 50 non-cirrhotic consecutive patients were included with primary or secondary liver cancer treatable by hepatectomy with a liver remnant (FLR) volume less than 25% or less than 40% in diseased livers. Results There were 37 men and 13 women with a mean age of 57 years. Colorectal liver metastases were the most frequent tumor and patients were previously exposed to chemotherapy. FLR increased from 422 ml to 629 ml (P < 0.001) after PVE, corresponding to anincrease of 52%. The FLR ratio increased from 29.6% to 42.3% (P < 0.001). Kinetic growth rate was 2.98%/week. A negative association was observed between increase in the FLR and FLR ratio and FLR volume before PVE (P = 0.002). In 31 patients hepatectomy was accomplished and only one patient presented with liver insufficiency within 30 days after surgery. Conclusions PVE with NBCA through an ipsilateral puncture is effective before major hepatectomy. Meticulous attention is needed especially near the end of the embolization procedure to avoid complications. Trial registration Clinical Study ISRCTN registration number: ISRCTN39855523. Registered March 13th 2017.
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Affiliation(s)
- José Hugo Mendes Luz
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil.
| | - Paula Mendes Luz
- National Institute of Infectious Disease EvandroChagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Tiago Bilhim
- Department of Interventional Radiology, Centro Hepato-Bilio-Pancreático e de Transplantação.Hospital Curry Cabral, CHLC, Lisbon, Portugal
| | - Henrique Salas Martin
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil
| | - Hugo Rodrigues Gouveia
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil
| | - Élia Coimbra
- Department of Interventional Radiology, Centro Hepato-Bilio-Pancreático e de Transplantação.Hospital Curry Cabral, CHLC, Lisbon, Portugal
| | - Filipe Veloso Gomes
- Department of Interventional Radiology, Centro Hepato-Bilio-Pancreático e de Transplantação.Hospital Curry Cabral, CHLC, Lisbon, Portugal
| | - Roberto Romulo Souza
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil
| | - Igor Murad Faria
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil
| | - Tiago Nepomuceno de Miranda
- Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Praça Cruz Vermelha 23, Centro, Rio de Janeiro, CEP 20230-130, Brazil
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Piron L, Deshayes E, Escal L, Souche R, Herrero A, Pierredon-Foulongne MA, Assenat E, le Lam N, Quenet F, Guiu B. [Portal vein embolization: Present and future]. Bull Cancer 2017; 104:407-416. [PMID: 28477870 DOI: 10.1016/j.bulcan.2017.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 12/12/2022]
Abstract
Portal vein embolization consists of occluding a part of the portal venous system in order to achieve the hypertrophy of the non-embolized liver segments. This technique is used during the preoperative period of major liver resection when the future remnant liver (FRL) volume is insufficient, exposing to postoperative liver failure, main cause of death after major hepatectomy. Portal vein embolization indication depends on the FRL, commonly assessed by its volume. Nowadays, FRL function evaluation seems more relevant and can be measured by 99mTc labelled mebrofenin scintigraphy. Portal vein embolization procedure is mostly performed with percutaneous trans-hepatic access by using ultrasonography guidance and consists of embolic agent injection, such as cyanoacrylate, in the targeted portal vein branches with fluoroscopic guidance. It is a safe and well-tolerated technique, with extremely low morbi-mortality. Portal vein embolization leads to sufficient FRL hypertrophy in about 80% of patients, allowing them to undergo surgery from which they were initially rejected. The two main reasons of non-resection are tumor progression (≈15% of cases) and FRL insufficient hypertrophy (≈5% of cases). When portal vein embolization is not enough to obtain adequate FRL regeneration, hepatic vein embolization may potentiate its effect (liver venous deprivation technique).
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Affiliation(s)
- Lauranne Piron
- Saint-Éloi University Hospital, Department of Radiology, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
| | - Emmanuel Deshayes
- Institut du Cancer de Montpellier, Department of Nuclear Medicine, 208, avenue des Apothicaires, 34298 Montpellier, France; Inserm U1194, 208, avenue des Apothicaires, 34298 Montpellier, France
| | - Laure Escal
- Saint-Éloi University Hospital, Department of Radiology, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - Regis Souche
- Saint-Éloi University Hospital, Department of Surgery, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - Astrid Herrero
- Saint-Éloi University Hospital, Department of Surgery, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | | | - Eric Assenat
- Saint-Éloi University Hospital, Department of Oncology, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - Ngo le Lam
- Bach Mai University Hospital, Department of Radiology, Hanoi, Viet Nam
| | - François Quenet
- Institut du Cancer de Montpellier, Department of Surgery, 208, avenue des Apothicaires, 34298 Montpellier, France
| | - Boris Guiu
- Saint-Éloi University Hospital, Department of Radiology, 80, avenue Augustin-Fliche, 34090 Montpellier, France; Inserm U1194, 208, avenue des Apothicaires, 34298 Montpellier, France
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9
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Updated Management of Malignant Biliary Tract Tumors: An Illustrative Review. J Vasc Interv Radiol 2016; 27:1056-69. [DOI: 10.1016/j.jvir.2016.01.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/12/2015] [Accepted: 01/27/2016] [Indexed: 12/18/2022] Open
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10
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Nilsson J, Eriksson S, Nørgaard Larsen P, Keussen I, Christiansen Frevert S, Lindell G, Sturesson C. Concurrent biliary drainage and portal vein embolization in preparation for extended hepatectomy in patients with biliary cancer. Acta Radiol Open 2015; 4:2058460115579121. [PMID: 25992300 PMCID: PMC4433626 DOI: 10.1177/2058460115579121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/04/2015] [Indexed: 01/04/2023] Open
Abstract
Background Patients with perihilar cholangiocarcinoma and gallbladder cancer extending into the hilum often present with jaundice and a small future liver remnant (FLR). If resectable, preoperative biliary drainage and portal vein embolization (PVE) are indicated. Classically, these measures have been performed sequentially, separated by 4–6 weeks. Purpose To report on a new regime where percutaneous transhepatic biliary drainage (PTBD) and PVE are performed simultaneously, shortening the preoperative process. Material and Methods Six patients were treated with concurrent PTBD and PVE under general anesthesia. Results Surgical exploration followed the combined procedure after 35 days (range, 28–51 days). The FLR ratio increased from 22% to 32%. Three patients developed cholangitis after the procedure. Conclusion The combined approach of PTBD and PVE seems feasible, but more studies on morbidity are warranted.
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Affiliation(s)
- Jan Nilsson
- Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Sam Eriksson
- Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Peter Nørgaard Larsen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Denmark
| | - Inger Keussen
- Department of Radiology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Susanne Christiansen Frevert
- Department of Vascular and Interventional Radiology, Rigshospitalet, Faculty of Health Sciences, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Gert Lindell
- Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Christian Sturesson
- Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Denmark
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11
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Zhang W, Yan LN. Perihilar cholangiocarcinoma: Current therapy. World J Gastrointest Pathophysiol 2014; 5:344-354. [PMID: 25133034 PMCID: PMC4133531 DOI: 10.4291/wjgp.v5.i3.344] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/11/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Perihilar cholangiocarcinoma, which is a rare primary malignancy, originates from the epithelial cells of the bile duct. Usually invading the periductal tissues and the lymph nodes, perihilar cholangiocarcinoma is commonly diagnosed in the advanced stage of the disease and has a dismal prognosis. Currently, complete hepatectomy is the primary therapy for curing this disease. Perioperative assessment and available surgical procedures can be considered for achieving a negative margin resection, which is associated with long-term survival and better quality of life. For patients with unresectable cholangiocarcinoma, several palliative treatments have been demonstrated to produce a better outcome; and liver transplantation for selected patients with perihilar cholangiocarcinoma is promising and desirable. However, the role of palliative treatments and liver transplantation was controversial and requires more evidence and substantial validity from multiple institutions. In this article, we summarize the data from multiple institutions and discuss the resectability, mortality, morbidity and outcome with different approaches.
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12
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Govil S, Reddy MS, Rela M. Surgical resection techniques for locally advanced hilar cholangiocarcinoma. Langenbecks Arch Surg 2014; 399:707-16. [DOI: 10.1007/s00423-014-1216-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 05/13/2014] [Indexed: 12/15/2022]
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13
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Mertens J. Clinical diagnosis and management of perihilar cholangiocarcinoma. Clin Liver Dis (Hoboken) 2014; 3:60-64. [PMID: 30992887 PMCID: PMC6448701 DOI: 10.1002/cld.328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Joachim Mertens
- Department of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland.
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