SIR 2024
Interventional Oncology
Mohammad Mahdi Khavandi, MD
Postdoctoral research fellow
MD Anderson Cancer Center
Financial relationships: Full list of relationships is listed on the CME information page.
Ethan Y. Lin, MD
Assistant Professor
MD Anderson Cancer Center
Financial relationships: Full list of relationships is listed on the CME information page.
Bruno C. Odisio, MD, FSIR (he/him/his)
Interventional Radiologist
MD Anderson Cancer Center
Disclosure information not submitted.
Mohamed E. Abdelsalam, MD,M.Sc. (he/him/his)
Assitant Professor
UT MD Anderson Cancer Center
Disclosure information not submitted.
Ching Wei Tzeng, MD
Associate Professor
MD Anderson Cancer Center
Disclosure information not submitted.
Steven Y. Huang, MD, FSIR
Professor
The University of Texas MD Anderson
Disclosure information not submitted.
Peiman Habibollahi, MD, RPVI
Assistant Professor
MD Anderson Cancer Center
Financial relationships: Full list of relationships is listed on the CME information page.
Liver venous deprivation (LVD), a novel approach involving simultaneous portal vein and hepatic vein embolization, offers a strategy to maximize liver hypertrophy and enhance the future liver remnant (FLR) prior to hepatectomy in order to optimize post-operative outcomes. This study examines the safety and efficacy of LVD prior to hepatectomy.
Materials and Methods: Twenty consecutive patients diagnosed with hepatic malignancies (mean age [SD] of 53.1 [10.1] and male:female ratio of 16:4) who underwent LVD from September 2018 to August 2023 at a large referral cancer center were included in the study and retrospectively analyzed. All LVDs were performed using microparticles and coils in the portal vein and n-BCA and Amplatzer plugs in the hepatic vein. Pre- and post-intervention FLR volumes were quantified using CT volumetric analysis, and standardized liver volume was calculated using the Vauthey formula {1}. To evaluate LVD effectiveness, the degree of hypertrophy (DH) and kinetic growth rate (KGR) were calculated based on the FLR volume changes.
Results: The indication for hepatectomy was metastatic colorectal cancer in 17 (85%), cholangiocarcinoma in 2 (10%), and gastric adenocarcinoma in 1 (5%). There were no complications from LVD that resulted in aborting hepatectomy. Sixteen patients (80%) had adequate liver hypertrophy after LVD to allow hepatectomy, while 4 of 20 (20%) had inadequate liver hypertrophy. In 2 patients (10%) second-stage hepatectomy was aborted despite having adequate hypertrophy due to severe adhesions. There were no statistically significant differences observed in total bilirubin levels, albumin concentrations, and INR (International Normalized Ratio) values between the surgery-eligible group and the surgery-ineligible group. The mean (SD) pre-LVD and post-LVD FLR volumes were 517.1 (40.1) and 745.7 (153.7) ml, respectively (p < 0.00). The mean (SD) calculated KGR and DH within 4-6 weeks after LVD were 3.93(2.93) and 13.47% (6.80%), respectively. Mean (SD) KGR and DH were significantly higher in the surgery-eligible group than in the surgery-ineligible group (KGR: 4.58 [2.83] vs 1.3 [1.68], p=0.04; DH: 15.78% [5.08%] vs 4.19% [4.5%], p=0.001).
Conclusion:
These findings demonstrate the safety and efficacy of LVD for enhancing FLR prior to hepatectomy in patients with hepatic malignancy.