Optimizing future remnant liver prior to major hepatectomies: increasing volume while decreasing morbidity and mortality

摘要

Post hepatectomy liver failure (PHLF) remains the most dreaded complication in major hepatectomies. Adequate future remnant liver (FRL) plays a pivotal role in prevention of PHLF. Pre-operative portal vein embolization (PVE) has become standard of care for increasing the FRL in preparation for major hepatectomies. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has also been used, though has demonstrated a substantial risk of morbidity and mortality. However, there are many situations in which PVE achieves an inadequate extent of hypertrophy, potential increasing the risk of PHLF. Panaro and colleagues explore their data with a prospective review of preoperative PVE versus liver venous deprivation (LVD) regarding intra and post-operative complications, as well as, histologic findings ( ). This study adds to a growing body of literature assessing the benefit of LVD over PVE and ALPPS both, in regards to increased rate of hypertrophy, improvement in FRL, in the face of similar morbidity/mortality rates compared to PVE.