EFFECTIVENESS OF PORTAL BLOOD FLOW OCCLUSION TECHNIQUES WHEN PLANNING EXTENSIVE RESECTIONS IN PATIENTS WITH LIVER ECHINOCOCCOSIS
Abstract
Background. Surgery is the main and an effective treatment option for liver echinococcosis. The choice of surgical strategy for advanced liver echinococcosis given suspected poor liver functional reserve and post-operative hepatic failure remains challenging. Objective. To present and analyze the effectiveness of portal blood flow occlusion techniques in planning two-stage extensive resections in patients with advanced liver echinococcosis. Material and methods. The article presents the outcomes of surgical treatment of 22 patients (8/36,4% men, 14/63,6% women) operated on for advanced liver echinococcosis in the surgical department No.2 of State Autonomous Healthcare Institution ‘Kuzbass Clinical Emergency Hospital named after A.I. M. A. Podgorbunsky’ (Kemerovo). The application of a two-stage extensive resection protocol was used as an entry criterion. Stage I included right portal vein branch occlusion techniques aimed at achieving vicarious hypertrophy of the contralateral lobe. A two-stage extensive resection protocol was applied in case of both expected poor hepatic functional reserve and insufficient future remnant liver volume, accounting for inability of safe implementation of a one-stage extensive resection due to predicted postoperative hepatic failure and a fatal outcome. Results. The applied two-stage resection techniques for the prevention of post-operative hepatic failure are effective in relation to the following indicators: CT volumetry (p<0,05), OK15 ICG (p<0,05), statistical model value (p<0.05). Though the laparotomic technique of the right portal vein branch ligation is of a comparable effectiveness with the laparoscopic one, the latter being less traumatic, which can significantly reduce postoperative hospital stay (p<0,05). Moreover, the laparoscopic technique was not found to cause any specific and nonspecific complications. Conclusions. The applied methods of portal blood flow occlusion are considered to be effective and safe when planning two-stage extensive resections in specialized hepatology centers and can be recommended in case of initial poor hepatic functional reserve and insufficient future remnant liver volume.
References
Baimakhanov Z, Kaniyev S, Serikuly E, Doskhanov M, Askeyev B, Baiguissova D, Skakbayev A, Sadykov C, Barlybay R, Seisembayev M, Baimakhanov B. Radical versus conservative surgical management for liver hydatid cysts: A single-center prospective cohort study. JGH Open. 2021;5(10):1179-1182. https://doi.org/10.1002/jgh3.12649.
Ramia JM, Serrablo A, Serradilla M, Lopez-Marcano A, de la Plaza R, Palomares A. Major hepatectomies in liver cystic echinococcosis: A bi-centric experience. Retrospective cohort study. Int J Surg. 2018;54(Pt A):182-186. https://doi.org/10.1016/j.ijsu.2018.04.049.
Gomez I Gavara C, López-Andújar R, Belda Ibáñez T, Ramia Ángel JM, Moya Herraiz Á, Orbis Castellanos F, Pareja Ibars E, San Juan Rodríguez F. Review of the treatment of liver hydatid cysts. World J Gastroenterol. 2015;21(1):124-131. https://doi.org/10.3748/wjg.v21.i1.124.
Bayrak M, Altıntas Y. Current approaches in the surgical treatment of liver hydatid disease: single center experience. BMC Surg. 2019;19(1):95. https://doi.org/10.1186/s12893-019-0553-1.
Ibrahim I, Yasheng A, Tuerxun K, Xu QL, Tuerdi M, Wu YQ. Effectiveness of a Clinical Pathway for Hepatic Cystic Echinococcosis Surgery in Kashi Prefecture, Northwestern China: A Propensity Score Matching Analysis. Infect Dis Ther. 2021;10(3):1465-1477. https://doi.org/10.1007/s40121-021-00466-y.
Deo KB, Kumar R, Tiwari G, Kumar H, Verma GR, Singh H. Surgical management of hepatic hydatid cysts –conservative versus radical surgery. HPB (Oxford). 2020;22(10):1457-1462. https://doi.org/10.1016/j.hpb.2020.03.003.
Farhat W, Ammar H, Rguez A, Harrabi F, Said MA, Ghabry L, Gupta R, Ben Cheikh A, Ghali H, Ben Rajeb M, Ben Mabrouk M, Ben Ali A. Radical versus conservative surgical treatment of liver hydatid cysts: A paired comparison analysis. Am J Surg. 2022;224(1 Pt A):190-195. https://doi.org/10.1016/j.amjsurg.2021.12.014.
Ramia Ángel JM, Manuel Vázquez A, Gijón Román C, Latorre Fragua R, de la Plaza Llamas R. Radical surgery in hepatic hydatidosis: analysis of results in an endemic area. Rev Esp Enferm Dig. 2020;112(9):708-711. https://doi.org/10.17235/reed.2020.6722/2019.
Chansangrat J, Keeratibharat N. Portal vein embolization: rationale, techniques, outcomes and novel strategies. Hepat Oncol. 2021;8(4):HEP42. https://doi.org/10.2217/hep-2021-0006.
Dueland S, Yaqub S, Syversveen T, Carling U, Hagness M, Brudvik KW, Line PD. Survival Outcomes After Portal Vein Embolization and Liver Resection Compared with Liver Transplant for Patients with Extensive Colorectal Cancer Liver Metastases. JAMA Surg. 2021;156(6):550-557. https://doi.org/10.1001/jamasurg.2021.0267.
Heil J, Schadde E. Simultaneous portal and hepatic vein embolization before major liver resection. Langenbecks Arch Surg. 2021;406(5):1295-1305. https://doi.org/10.1007/s00423-020-01960-6.
Kohno S, Isoda H, Ono A, Furuta A, Taura K, Shibata T, Togashi K. Portal Vein Embolization: Radiological Findings Predicting Future Liver Remnant Hypertrophy. Am J Roentgenol. 2020;214(3):687-693. https://doi.org/10.2214/AJR.19.21440.
Nozawa Y, Ashida H, Michimoto K, Kisaki S, Kano R, Ojiri H, Ikegami T. Efficacy of Portal Vein Embolization with a Procedure of Sheath Injection and Balloon Occlusion with Gelatin Sponge. J Belg Soc Radiol. 2021;105(1):42. https://doi.org/10.5334/jbsr.2485.
Okada M, Ihara K, Miyoshi K, Nakao S, Tanabe M, Tokumitsu Y, Harada E, Sakamoto K, Nagano H, Ito K. Portal vein embolization via the ipsilateral percutaneous transhepatic approach versus laparotomic transileocecal approach: complications, profile and changes in future liver remnant volume. Br J Radiol. 2022;95(1135):20210854. https://doi.org/10.1259/bjr.20210854.
Yamao T, Tamura Y, Hayashi H, Takematsu T, Higashi T, Yamamura K, Imai K, Yamashita YI, Ikeda O, Baba H. Novel Approach via the Round Ligament in Portal Vein Embolization. World J Surg. 2021;45(9):2878-2885. https://doi.org/10.1007/s00268-021-06145-w.
Krasnov AO. Sovremennye kriterii operabelnosti u bolnyh s obemnymi obrazovanijami pecheni [master's thesis]. Novosibirsk (Russian Federation): Novosibirsk State Medical University; 2017. 22 p. (Russian).
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae.
Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Büchler MW, Weitz J. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149(5):680-688. https://doi.org/10.1016/j.surg.2010.12.002.
Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Büchler MW, Weitz J. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713-724. https://doi.org/10.1016/j.surg.2010.10.001.
Rahbari NN, Garden OJ, Padbury R, Maddern G, Koch M, Hugh TJ, Fan ST, Nimura Y, Figueras J, Vauthey JN, Rees M, Adam R, Dematteo RP, Greig P, Usatoff V, Banting S, Nagino M, Capussotti L, Yokoyama Y, Brooke-Smith M, Crawford M, Christophi C, Makuuchi M, Büchler MW, Weitz J. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford). 2011;13(8):528-535. https://doi.org/10.1111/j.1477-2574.2011.00319.x.
1.png)
