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

doi:10.1148/rg.220050

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 journal › Article › peer-review

7 Scopus citations

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 language	English (US)
Pages (from-to)	2166-2183
Number of pages	18
Journal	Radiographics
Volume	42
Issue number	7
DOIs	https://doi.org/10.1148/rg.220050
State	Published - Nov 1 2022

Funding

AstraZeneca, Boston Scientific, Eisai, Genentech, Histoson-ics, Johnson and Johnson, Sirtex Medical, Terumo, Turnstone Biologics, and Vivos. S.P. Research grant from Varian Medical Systems; consultant for Boston Scientific, Delicate, Teleflex, and Varian Medical Systems. R.S. Consultant for Bard, Boston Scientific, and Sirtex. J.D.C. Grants from the National Institutes of Health, travel support from Siemens Healthineers, and stock or stock options in Ceta. R.J.L. Grant from the National Institutes of Health; consultant for ABK Medical, BD, Boston Scientific, and Varian Medical Systems; lecturer for Boston Scientific; support for travel from and leadership or fiduciary role for the Society of Interventional Radiology.

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

Access to Document

10.1148/rg.220050

Cite this

@article{cb1a9fa5a29546beb9e5d93f1729edbc,

title = "Promoting Surgical Resection through Future Liver Remnant Hypertrophy",

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.",

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

note = "Publisher Copyright: {\textcopyright} RSNA, 2022.",

year = "2022",

month = nov,

day = "1",

doi = "10.1148/rg.220050",

language = "English (US)",

volume = "42",

pages = "2166--2183",

journal = "Radiographics",

issn = "0271-5333",

publisher = "Radiological Society of North America Inc.",

number = "7",

}

TY - JOUR

T1 - Promoting Surgical Resection through Future Liver Remnant Hypertrophy

AU - Entezari, Pouya

AU - Toskich, Beau B.

AU - Kim, Edward

AU - Padia, Siddharth

AU - Christopher, Derrick

AU - Sher, Alex

AU - Thornburg, Bartley

AU - Hohlastos, Elias S.

AU - Salem, Riad

AU - Collins, Jeremy D.

AU - Lewandowski, Robert J.

PY - 2022/11/1

Y1 - 2022/11/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85140974078&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85140974078&partnerID=8YFLogxK

U2 - 10.1148/rg.220050

DO - 10.1148/rg.220050

M3 - Article

C2 - 36206182

AN - SCOPUS:85140974078

SN - 0271-5333

VL - 42

SP - 2166

EP - 2183

JO - Radiographics

JF - Radiographics

IS - 7

ER -

Promoting Surgical Resection through Future Liver Remnant Hypertrophy

Abstract

Funding

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this