Promoting Surgical Resection through Future Liver Remnant Hypertrophy

Pouya Entezari, Beau B. Toskich, Edward Kim, Siddharth Padia, Derrick Christopher, Alex Sher, Bartley Thornburg, Elias S. Hohlastos, Riad Salem, Jeremy D Collins, Robert J. Lewandowski*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

An inadequate future liver remnant (FLR) can preclude curative-intent surgical resection for patients with primary or secondary hepatic malignancies. For patients with normal baseline liver function and without risk factors, an FLR of 20% is needed to maintain postsurgical hepatic function. However, the FLR requirement is higher for patients who are exposed to systemic chemotherapy (FLR, >30%) or have cirrhosis (FLR, >40%). Interventional radiologic and surgical methods to achieve FLR hypertrophy are evolving, including portal vein ligation, portal vein embolization, radiation lobectomy, hepatic venous deprivation, and associating liver partition and portal vein ligation for staged hepatectomy. Each technique offers particular advantages and disadvantages. Knowledge of these procedures can help clinicians to choose the suitable technique for each patient. The authors review the techniques used to develop FLR hypertrophy, focusing on technical considerations, outcomes, and the advantages and disadvantages of each approach.

Original languageEnglish (US)
Pages (from-to)2166-2183
Number of pages18
JournalRadiographics
Volume42
Issue number7
DOIs
StatePublished - Nov 1 2022

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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