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Management of future liver remnant: strategies to promote hepatic hypertrophy

摘要The resectability of hepatocellular carcinoma (HCC) has been assessed based on the liver functional test, the liver volume of the future liver remnant (FLR), and, more recently, the functional liver volume of FLR. Liver volume is estimated via multi-detector computed tomography and three-dimensional image visualization technologies, and functional liver volume is investigated via 99mTc-galactosyl human serum albumin scintigraphy, 99mTc-mebrofenin hepatobiliary scintigraphy, and gadoxetic acid-enhanced magnetic resonance imaging. Several special techniques have been developed to promote FLR hypertrophy, thus allowing for safe hepatectomy. As an interventional technique, portal vein embolization (PVE) is essential, and, along with transarterial chemoembolization or hepatic vein embolization, this is beneficial in promoting a much larger FLR. Dual embolization is recommended for patients with very small FLR or with PVE failure. Radioembolization by Yttrium-90 microspheres (i.e., radiation lobectomy) can help in achieving FLR hypertrophy and has an anticancer effect on HCC. Transarterial chemoembolization on PVE has a similar anticancer effect. Surgical procedures, such as two-stage hepatectomy as well as associated liver partition and portal vein ligation for staged hepatectomy, are somewhat invasive. Therefore, they should be applied as a salvage procedure for patients with HCC who had inadequate response to the interventional approach. However, the best approach should be selected mainly based on the functional volume of FLR and the patients' condition; in addition, the resources of each facility should be considered.

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作者 Toru Beppu [1] Kensuke Yamamura [1] Hirohisa Okabe [2] Tatsunori Miyata [2] Yuki Kitano [2] Katsunori Imai [2] Hiromitsu Hayashi [2] Shinichi Akahoshi [1] 学术成果认领
作者单位 Department of Surgery,Yamaga City Medical Center,Yamaga 861-0593,Japan;Department of Gastroenterological Surgery,Graduate School of Life Sciences,Kumamoto University,Kumamoto 860-8556,Japan [1] Department of Gastroenterological Surgery,Graduate School of Life Sciences,Kumamoto University,Kumamoto 860-8556,Japan [2]
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DOI 10.20517/2394-5079.2021.49
发布时间 2022-05-19(万方平台首次上网日期,不代表论文的发表时间)
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