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BJS Open Nov 2022This meta-analysis aimed to compare progression to surgery, extent of liver hypertrophy, and postoperative outcomes in patients planned for major hepatectomy following... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This meta-analysis aimed to compare progression to surgery, extent of liver hypertrophy, and postoperative outcomes in patients planned for major hepatectomy following either portal vein embolization (PVE) or dual vein embolization (DVE) for management of an inadequate future liver remnant (FLR).
METHODS
An electronic search was performed of MEDLINE, Embase, and PubMed databases using both medical subject headings (MeSH) and truncated word searches. Articles comparing PVE with DVE up to January 2022 were included. Articles comparing sequential DVE were excluded. ORs, risk ratios, and mean difference (MD) were calculated using fixed and random-effects models for meta-analysis.
RESULTS
Eight retrospective studies including 523 patients were included in the study. Baseline characteristics between the groups, specifically, age, sex, BMI, indication for resection, and baseline FLR (ml and per cent) were comparable. The percentage increase in hypertrophy was larger in the DVE group, 66 per cent in the DVE group versus 27 per cent in the PVE group, MD 39.07 (9.09, 69.05) (P = 0.010). Significantly fewer patients failed to progress to surgery in the DVE group than the PVE group, 13 per cent versus 25 per cent respectively OR 0.53 (0.31, 0.90) (P = 0.020). Rates of post-hepatectomy liver failure 13 per cent versus 22 per cent (P = 0.130) and major complications 20 per cent versus 28 per cent (Clavien-Dindo more than IIIa) (P = 0.280) were lower. Perioperative mortality was lower with DVE, 1 per cent versus 10 per cent (P = 0.010).
CONCLUSION
DVE seems to produce a greater degree of hypertrophy of the FLR than PVE alone which translates into more patients progressing to surgery. Higher quality studies are needed to confirm these results.
Topics: Humans; Hepatectomy; Portal Vein; Retrospective Studies; Liver Neoplasms; Hypertrophy
PubMed: 36398754
DOI: 10.1093/bjsopen/zrac131 -
Medical Science Monitor : International... Mar 2023BACKGROUND This study aimed to evaluate the safety and efficacy of portal vein puncture with a new guidance system using double C-arm digital subtraction angiography...
BACKGROUND This study aimed to evaluate the safety and efficacy of portal vein puncture with a new guidance system using double C-arm digital subtraction angiography (DSA) during transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIAL AND METHODS The procedure details of TIPS placements performed on 39 patients in our center between January and December 2021 were retrospectively analyzed. The procedure was performed under double C-arm DSA guidance (study group) and C-arm DSA (control group) in 18 and 21 patients, respectively. We analyzed the procedure's technical success, duration of the overall procedure, portal vein puncture, fluoroscopy, radiation exposure, complications, and mortality and morbidity rates 30 days after the procedure. RESULTS TIPS placement was performed successfully in all patients. The mean portal vein puncture time in the study group (9±5.7 min) was significantly shorter than in the control group (33±14.9 min, p=0.02). The complete mean dose area product of the procedure showed no significant differences (study group, 126±53 Gy/cm²; control group. 142±66 Gy/cm²; p=0.42). The intraprocedural complication rates were 0% and 19% in the study and control groups, respectively (p=0.04). The 30-day post-procedural mortality rate in the control group was 4.8% (1/21), with no deaths from technical complications. CONCLUSIONS Double C-arm DSA guidance is a safe and effective method to assist TIPS placement. This approach may result in shorter portal vein puncture time and lower intraprocedural complication rates.
Topics: Humans; Portasystemic Shunt, Transjugular Intrahepatic; Angiography, Digital Subtraction; Retrospective Studies; Portal Vein; Punctures; Treatment Outcome
PubMed: 36922715
DOI: 10.12659/MSM.938912 -
Medicine Oct 2021Gastrointestinal bleeding caused by portal vein (PV) stenosis is serious complication after pancreaticoduodenectomy (PD) The purpose of this study is to reveal the...
Gastrointestinal bleeding caused by portal vein (PV) stenosis is serious complication after pancreaticoduodenectomy (PD) The purpose of this study is to reveal the long-term clinical outcomes of PV stenting for symptomatic PV stenosis and risk factors of stent related complication.Fifteen patients who underwent portal vein stenting for symptomatic PV stenosis after PD between 2000 and 2018 were retrospectively reviewed. The whole cohort was divided into 9 patients with benign stenosis group (Group-B) and 6 patients with recurrence group (Group-R).The median follow up period was 17.0 (interquartile range 12.0-38.0) months. The technical success rate and clinical success rate was revealed at 93.3% and 86.7%. The primary patency rate of stents was 79.4% and mean patency period was 14.0 (4.0-28.0) months. There was significant difference in time to stenosis and proportion of anticoagulation treatment between 2 groups [2.0 (1.0-4.0) months vs 18.5 (2.5-50.3) months, P = .035 and 100% vs 50%, P = .044. In univariable analysis, stent diameter was found to have a significant correlation with stent occlusion (P = .036).PV stenting was found to be feasible and safe in the treatment of symptomatic PV stenosis from a long term point of view.
Topics: Aged; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Pancreaticoduodenectomy; Portal Vein; Postoperative Complications; Retrospective Studies; Risk Factors; Stents; Time Factors; Treatment Outcome; Vascular Diseases
PubMed: 34596122
DOI: 10.1097/MD.0000000000027264 -
Surgical Endoscopy Jun 2020Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has gained both interest and controversy, as an alternative to portal vein... (Comparative Study)
Comparative Study Review
BACKGROUND
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has gained both interest and controversy, as an alternative to portal vein embolisation (PVE) by inducing future liver remnant hypertrophy in patients at risk of liver failure following major hepatectomy. Open ALPPS induces more extensive hypertrophy in a shorter timespan than PVE; however, it is also associated with higher complication rates and mortality. Minimally invasive surgery (MIS), with its known benefits, has been applied to ALPPS in the hope of reducing the surgical insult and improving functional recovery time while preserving the extensive FLR hypertrophy.
METHODS
A search of the PubMed, Medline, EMBASE and Cochrane Library databases was conducted on 10 July 2019. 1231 studies were identified and screened. 19 open ALPPS studies, 3 MIS ALPPS and 1 study reporting on both were included in the analysis.
RESULTS
1088 open and 46 MIS-ALPPS cases were included in the analysis. There were significant differences in the baseline characteristic: open ALPPS patients had a more diverse profile of underlying pathologies (p = 0.028) and comparatively more right extended hepatectomies (p = 0.006) as compared to right hepatectomy and left extended hepatectomy performed. Operative parameters (time and blood loss) did not differ between the two groups. MIS ALPPS had a lower rate of severe Clavien-Dindo complications (≥ IIIa) following stage 1 (p = 0.063) and significantly lower median mortality (0.00% vs 8.45%) (p = 0.007) compared to open ALPPS.
CONCLUSION
Although MIS ALPPS would seem to be better than open ALPPS with reduced morbidity and mortality rates, there is still limited evidence on MIS ALPPS. There is a need for a higher quality of evidence on MIS ALPPS vs. open ALPPS to answer whether MIS ALPPS can replace open ALPPS.
Topics: Embolization, Therapeutic; Female; Hepatectomy; Humans; Ligation; Liver; Liver Neoplasms; Male; Middle Aged; Minimally Invasive Surgical Procedures; Portal Vein
PubMed: 32274625
DOI: 10.1007/s00464-020-07437-3 -
HPB : the Official Journal of the... Jul 2022Right hepatectomy occasionally requires portal vein resection (PVR) and causes postoperative portal vein thrombosis (PVT).
BACKGROUND
Right hepatectomy occasionally requires portal vein resection (PVR) and causes postoperative portal vein thrombosis (PVT).
METHODS
A total of 247 patients who underwent right hepatectomy were evaluated using a three-dimensional analyzer to identify the morphologic changes in the portal vein (PV). The patients' characteristics were compared between the PVR group (n = 73) and non-PVR group (n = 174), and risk factors for PVT were investigated. The PVR group were subdivided into the wedge resection (WR) group (n = 38) and segmental resection (SR) group (n= 35).
RESULTS
Postoperative PVT occurred in 20 patients (8.1%). Multivariate analyses in all patients revealed that postoperative left PV diameter/main PV diameter (L/M ratio) <0.56 (odds ratio [OR] 4.00, p = 0.009) and PVR (OR 3.31, p = 0.031) were significant risk factors for PVT. In 73 patients who underwent PVR, PVT occurred in 14 (19%) and WR (OR 11.5, p = 0.005) and L/M ratio <0.56 (OR 5.51, p = 0.016) were significant risk factors for PVT.
CONCLUSION
PVR was one of the significant risk factors for PVT after right hepatectomy. SR rather than WR may be recommended for preventing PVT.
Topics: Hepatectomy; Humans; Liver Cirrhosis; Liver Diseases; Portal Vein; Retrospective Studies; Splenectomy; Venous Thrombosis
PubMed: 34991960
DOI: 10.1016/j.hpb.2021.12.004 -
BMJ Case Reports May 2022
Topics: Humans; Listeria monocytogenes; Liver Diseases; Phlebitis; Portal Vein
PubMed: 35580955
DOI: 10.1136/bcr-2022-250014 -
Cardiovascular and Interventional... Mar 2021To describe the technique and outcomes of mesenteric access under ultrasound guidance to perform portal vein recanalization-transjugular intrahepatic portosystemic shunt...
OBJECTIVE
To describe the technique and outcomes of mesenteric access under ultrasound guidance to perform portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS).
METHODS
Four patients (3 male: 1 female, mean age: 46.2 years; range 38-64 years) with portal vein thrombosis (PVT) and cavernous transformation were eligible for PVR-TIPS. Due to inaccessible splenic vein (one patient with history of splenectomy and 3 patients with unavailable splenic vein during the procedure), noninvasive direct puncture of superior (n = 3) and inferior (n = 1) mesenteric vein was conducted under ultrasound guidance to obtain access for PVR-TIPS.
RESULTS
Trans-mesenteric access and PVR-TIPS were successful in all patients at first attempt. No immediate complication was observed following the procedures. Follow-up imaging with computed tomography (CT) scan and Doppler ultrasound revealed patent TIPS and portal venous vasculature in all patients.
CONCLUSION
Percutaneous noninvasive transmesenteric access is a feasible approach for PVR-TIPS in patients with inaccessible splenic veins.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Adult; Female; Humans; Male; Mesenteric Veins; Middle Aged; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Interventional; Venous Thrombosis
PubMed: 33230650
DOI: 10.1007/s00270-020-02713-0 -
Canadian Journal of Surgery. Journal... Mar 2021Portal vein arterialization (PVA) is a possible option when hepatic artery reconstruction is impossible during liver resection. The aim of this study was to review the...
BACKGROUND
Portal vein arterialization (PVA) is a possible option when hepatic artery reconstruction is impossible during liver resection. The aim of this study was to review the literature on the clinical application of PVA in hepatopancreatobiliary (HPB) surgery.
METHODS
We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the PubMed, Embase and Web of Science databases until December 2019. Experimental (animal) studies, review articles and letters were excluded.
RESULTS
Twenty studies involving 57 patients were included. Cholangiocarcinoma was the most common indication for surgery (40 patients [74%]). An end-to-side anastomosis between a celiac trunk branch and the portal vein was the main PVA technique (35 patients [59%]). Portal hypertension was the most common longterm complication (12 patients [21%] after a mean of 4.1 mo). The median followup period was 12 (range 1-87) months. The 1-, 3- and 5-year survival rates were 64%, 27% and 20%, respectively.
CONCLUSION
Portal vein arterialization can be considered as a rescue option to improve the outcome in patients with acute liver de-arterialization when arterial reconstruction is not possible. To prevent portal hypertension and liver injuries due to thrombosis or overarterialization, vessel calibre adjustment and timely closure of the anastomosis should be considered. Further prospective experimental and clinical studies are needed to investigate the potential of this procedure in patients whose liver is suddenly de-arterialized during HPB procedures.
Topics: Bile Ducts; Digestive System Surgical Procedures; Humans; Liver; Pancreas; Portal Vein
PubMed: 33739801
DOI: 10.1503/cjs.012419 -
Folia Morphologica 2023Hepatobilliary surgery is nowadays growing with increasing popularity throughout the world with advent of newer liver imaging modalities. Anticipating a wide range of...
BACKGROUND
Hepatobilliary surgery is nowadays growing with increasing popularity throughout the world with advent of newer liver imaging modalities. Anticipating a wide range of morphological variations of porta hepatis (PH), a precise understanding is pertinent to preoperative diagnosis, operative procedure and post-operative outcome of hepatobiliary disease.
MATERIALS AND METHODS
Considering recent interest, present study was undertaken. One-hundred and ten isolated adult cadaveric livers of unknown age and sex were dissected to explore detail morphology and morphometry of PH.
RESULTS
Classical picture of PH was observed in 20% liver. The standard representation of structures was highest in hepatic artery (59.1%) followed by portal vein (55.5%) and hepatic duct (51.8%). On the basis of structural distribution PH was described as 16 types. Maximum variable number was found in hepatic artery followed by portal vein and hepatic duct. In morphometric analysis, transverse diameter of PH was more than antero-posterior diameter, indicated that PH was slightly oval in transverse plane. Position of PH was more towards posterior and slightly right in inferior surface of liver.
CONCLUSIONS
Variations of portal anatomy regarding circulatory and biliary dynamics is worth knowing in successful planning of hepatobiliary surgeries with least complications.
Topics: Adult; Humans; Liver; Hepatic Artery; Portal Vein
PubMed: 35607875
DOI: 10.5603/FM.a2022.0047 -
HPB : the Official Journal of the... Aug 2022Portal venous reconstruction (PVR) is often needed during resection of hepatopancreato-biliary (HPB) malignancies. Primary repair (PR), autologous vein (AV), or...
BACKGROUND
Portal venous reconstruction (PVR) is often needed during resection of hepatopancreato-biliary (HPB) malignancies. Primary repair (PR), autologous vein (AV), or cryopreserved cadaveric vein (CCV) are frequently utilized, however relative patency is not well studied.
METHODS
All patients undergoing PVR between 2007-2019 at our center were identified. 3-year primary patency (PP), overall survival (OS), and survival-adjusted patency (SAP) were evaluated with Kaplan-Meier and Cox proportional hazards modeling.
RESULTS
One-hundred-twenty patients were identified with a median follow-up of 11 months. PR, AV, and CCV reconstruction were used in 28 (23%), 35 (29%), and 57 (48%) patients, respectively, with two (7%), four (11%), and 29 (51%) thromboses, respectively. 3-year PP was greater for both primary repair (90%) and AV (83%) compared to CCV (33%, both p<0.001). On multivariable analysis, CCV had worse 3-year PP (HR 7.89, p=0.005) and SAP (HR 2.09, p=0.02) compared to PR; AV reconstruction had equivalent oncologic and patency-related outcomes to PR (p>0.4 for both comparisons).
CONCLUSIONS
Primary patency for PR and AV reconstruction is superior to CCV for PVR during resection of HPB malignancies. AV conduit should be the preferred choice of reconstruction when PR is not achievable. Surgeons should only use CCV when factors preclude PR/AV reconstruction.
Topics: Cadaver; Humans; Pancreatic Neoplasms; Portal Vein; Retrospective Studies; Treatment Outcome; Vascular Patency
PubMed: 35135725
DOI: 10.1016/j.hpb.2022.01.004