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Review Article   

Minerva Surgery 2022 Mar 25

DOI: 10.23736/S2724-5691.22.09541-7

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Future remnant Liver optimization: preoperative assessment, volume augmentation procedures and management of PVE failure

Gianluca CASSESE 1, 2, Ho-Seong HAN 2, Abdallah AL FARAI 3, Boris GUIU 4, Roberto I. TROISI 1, Fabrizio PANARO 5

1 Minimally Invasive and Robotic HPB Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; 2 Seoul National University College of Medicine, Department of Surgery, Seoul National University Bundang Hospital, Seoul, South Korea; 3 Department of Surgical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman; 4 Department of Radiology, Montpellier University Hospital, Montpellier, France; 5 Montpellier University Hospital School of Medicine, Unit of Digestive Surgery and Liver Transplantation, Montpellier University Hospital, Montpellier-Nimes University, Montpellier, France


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Surgery is the cornerstone treatment for patients with primary or metastatic hepatic tumors. Thanks to surgical and anesthetic technological advances, current indications for liver resections have been significantly expanded to include any patient in whom all disease can be resected with a negative margin (R0) while preserving an adequate future residual liver (FRL). Post-hepatectomy liver failure (PHLF) is still a feared complication following major liver surgery, associated with high morbidity, mortality and cost implications. PHLF is mainly linked to both the size and quality of the FRL. Significant advances have been made in detailed preoperative assessment, to predict and mitigate this complication, even if an ideal methodology has yet to be defined. Several procedures have been described to induce hypertrophy of the FRL when needed. Each technique has its advantages and limitations, and among them portal vein embolization (PVE) is still considered the standard of care. About 20% of patients after PVE fail to undergo the scheduled hepatectomy, and newer secondary procedures, such as segment 4 embolization, ALPPS and HVE, have been proposed as salvage strategies. The aim of this review is to discuss the current modalities available and new perspectives in the optimization of FRL in patients undergoing major liver resection.


KEY WORDS: Future remnant liver; Preoperative liver assessment; FRL optimization; Volume augmentation procedures; PVE failure

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