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Title: Feasibility of Percutaneous Intrahepatic Split by Microwave Ablation (PISA) After Portal Vein Embolization for Hypertrophy of Future Liver Remnant: The Radiological Stage-1 ALPPS

Abstract

PurposeTo assess the feasibility of radiological stage-1 ALPPS, associating liver partition and portal vein ligation for staged hepatectomy, by combining portal vein embolization (PVE) with percutaneous intrahepatic split by ablation (PISA).Materials and MethodsThree patients (mean age 65.0 ± 7.3 years) underwent PVE and PISA. PISA was performed 21 days after PVE by microwave ablation to create a continuous intrahepatic cutting plane. Abdominal CT examinations were performed before and after PVE and PISA. The future liver remnant (FLR) volume was calculated by semiautomatic segmentation, and increase was reported as a percentage of the pre-procedural volume. The FLR/body weight (FLR/BW) ratio was calculated; a ratio greater than 0.8% was considered sufficient for guaranteeing adequate liver function after surgery. The liver function before and after PISA was also evaluated by 99mTc-mebrofenin hepatobiliary scintigraphy. Patients’ laboratory tests, performance status, ability to walk were assessed before and after PVE and PISA procedures.ResultsNo procedure-related complications were recorded. The FLR volume increase in each patient was 42.0, 33.1 and 30.4% within 21 days of PVE and 109.3, 68.1 and 71.7% within 10 days after PISA. The FLR/BW ratios were 0.76, 0.66, 0.63% and 1.13, 0.83, 0.83% after PVE and PISA procedures, respectively. Two patients underwent successful right hepatectomy; in one patient, despite 1.13%more » FLR/BW, surgery was not performed because of the absolute rejection of blood transfusion due to the patient’s religious convictions.ConclusionRadiological stage-1 ALPPS is a feasible, minimally invasive option to be further investigated to become an effective alternative to surgical stage-1 ALPPS.« less

Authors:
;  [1];  [2];  [1];  [3]; ; ;  [1]; ;  [4]; ;  [1];  [3]
  1. University of Pisa, Division of Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, Azienda Ospedaliero Universitaria Pisana (Italy)
  2. University of Pisa, Division of Nuclear Medicine, Department of Translational Research and New Technologies in Medicine and Surgery (Italy)
  3. University of Pisa, Division of General and Transplant Surgery, Department of Translational Research and New Technologies in Medicine and Surgery (Italy)
  4. University of Pisa, Division of Pathology, Department of Laboratory Medicine (Italy)
Publication Date:
OSTI Identifier:
22750029
Resource Type:
Journal Article
Journal Name:
Cardiovascular and Interventional Radiology
Additional Journal Information:
Journal Volume: 41; Journal Issue: 5; Other Information: Copyright (c) 2018 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0174-1551
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABLATION; LIVER; MICROWAVE RADIATION; PATIENTS; VASCULAR DISEASES; VEINS

Citation Formats

Lunardi, Alessandro, Cervelli, Rosa, Volterrani, Duccio, Vitali, Saverio, Lombardo, Carlo, Lorenzoni, Giulia, Crocetti, Laura, Bargellini, Irene, Campani, Daniela, Pollina, Luca Emanuele, Cioni, Roberto, Caramella, Davide, and Boggi, Ugo. Feasibility of Percutaneous Intrahepatic Split by Microwave Ablation (PISA) After Portal Vein Embolization for Hypertrophy of Future Liver Remnant: The Radiological Stage-1 ALPPS. United States: N. p., 2018. Web. doi:10.1007/S00270-018-1882-7.
Lunardi, Alessandro, Cervelli, Rosa, Volterrani, Duccio, Vitali, Saverio, Lombardo, Carlo, Lorenzoni, Giulia, Crocetti, Laura, Bargellini, Irene, Campani, Daniela, Pollina, Luca Emanuele, Cioni, Roberto, Caramella, Davide, & Boggi, Ugo. Feasibility of Percutaneous Intrahepatic Split by Microwave Ablation (PISA) After Portal Vein Embolization for Hypertrophy of Future Liver Remnant: The Radiological Stage-1 ALPPS. United States. doi:10.1007/S00270-018-1882-7.
Lunardi, Alessandro, Cervelli, Rosa, Volterrani, Duccio, Vitali, Saverio, Lombardo, Carlo, Lorenzoni, Giulia, Crocetti, Laura, Bargellini, Irene, Campani, Daniela, Pollina, Luca Emanuele, Cioni, Roberto, Caramella, Davide, and Boggi, Ugo. Tue . "Feasibility of Percutaneous Intrahepatic Split by Microwave Ablation (PISA) After Portal Vein Embolization for Hypertrophy of Future Liver Remnant: The Radiological Stage-1 ALPPS". United States. doi:10.1007/S00270-018-1882-7.
@article{osti_22750029,
title = {Feasibility of Percutaneous Intrahepatic Split by Microwave Ablation (PISA) After Portal Vein Embolization for Hypertrophy of Future Liver Remnant: The Radiological Stage-1 ALPPS},
author = {Lunardi, Alessandro and Cervelli, Rosa and Volterrani, Duccio and Vitali, Saverio and Lombardo, Carlo and Lorenzoni, Giulia and Crocetti, Laura and Bargellini, Irene and Campani, Daniela and Pollina, Luca Emanuele and Cioni, Roberto and Caramella, Davide and Boggi, Ugo},
abstractNote = {PurposeTo assess the feasibility of radiological stage-1 ALPPS, associating liver partition and portal vein ligation for staged hepatectomy, by combining portal vein embolization (PVE) with percutaneous intrahepatic split by ablation (PISA).Materials and MethodsThree patients (mean age 65.0 ± 7.3 years) underwent PVE and PISA. PISA was performed 21 days after PVE by microwave ablation to create a continuous intrahepatic cutting plane. Abdominal CT examinations were performed before and after PVE and PISA. The future liver remnant (FLR) volume was calculated by semiautomatic segmentation, and increase was reported as a percentage of the pre-procedural volume. The FLR/body weight (FLR/BW) ratio was calculated; a ratio greater than 0.8% was considered sufficient for guaranteeing adequate liver function after surgery. The liver function before and after PISA was also evaluated by 99mTc-mebrofenin hepatobiliary scintigraphy. Patients’ laboratory tests, performance status, ability to walk were assessed before and after PVE and PISA procedures.ResultsNo procedure-related complications were recorded. The FLR volume increase in each patient was 42.0, 33.1 and 30.4% within 21 days of PVE and 109.3, 68.1 and 71.7% within 10 days after PISA. The FLR/BW ratios were 0.76, 0.66, 0.63% and 1.13, 0.83, 0.83% after PVE and PISA procedures, respectively. Two patients underwent successful right hepatectomy; in one patient, despite 1.13% FLR/BW, surgery was not performed because of the absolute rejection of blood transfusion due to the patient’s religious convictions.ConclusionRadiological stage-1 ALPPS is a feasible, minimally invasive option to be further investigated to become an effective alternative to surgical stage-1 ALPPS.},
doi = {10.1007/S00270-018-1882-7},
journal = {Cardiovascular and Interventional Radiology},
issn = {0174-1551},
number = 5,
volume = 41,
place = {United States},
year = {2018},
month = {5}
}