| Controversies in the use of portal vein embolization. | |
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MedLine Citation:
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PMID: 19212116 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND/AIMS: Portal vein embolization (PVE) has reached worldwide acceptance to increase future remnant liver (FRL) volume before undertaking major liver resection. The aim of this overview is to point out and discuss current controversies in the application of PVE. METHODS: Review of literature pertaining to techniques of PVE, complications, tumor proliferation, timing of resection, and hypertrophy response after PVE. RESULTS: Procedure-related complications after PVE include hematoma, hemobilia, overflow of embolization material, and thrombosis of portal vein branch(es) of the non-embolized lobe. Persistence of the embolized, atrophic lobe is usually not harmful. Embolization of the portal branches to segment 4 in addition to embolization of the right portal trunk is controversial and is advised only in selected cases. It remains undecided whether embolization of the portal venous system is more effective in inducing hypertrophy of the FRL than ligation of the portal vein. Accelerated tumor growth after PVE is a major concern and requires consideration of post-PVE chemotherapy. A waiting time of 3 weeks between PVE and liver resection is advised. Post-hepatectomy regeneration is not hampered after preoperative PVE. CONCLUSION: PVE is a useful preoperative intervention to increase volume and function of the FRL. Further progress awaits clarification of the mechanisms of the hypertrophy response induced by PVE in conjunction with new embolization materials and protective chemotherapy. |
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Authors:
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Thomas M van Gulik; Jacomina W van den Esschert; Wilmar de Graaf; Krijn P van Lienden; Olivier R C Busch; Michal Heger; Otto M van Delden; Johan S Laméris; Dirk J Gouma |
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Publication Detail:
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Type: Journal Article; Review Date: 2009-02-12 |
Journal Detail:
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Title: Digestive surgery Volume: 25 ISSN: 1421-9883 ISO Abbreviation: Dig Surg Publication Date: 2008 |
Date Detail:
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Created Date: 2009-02-12 Completed Date: 2009-05-05 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8501808 Medline TA: Dig Surg Country: Switzerland |
Other Details:
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Languages: eng Pagination: 436-44 Citation Subset: IM |
Copyright Information:
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(c) 2009 S. Karger AG, Basel. |
Affiliation:
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Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. t.m.vangulik@amc.uva.nl |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Combined Modality Therapy Embolization, Therapeutic / adverse effects, methods* Female Hepatectomy / methods* Humans Liver Neoplasms / blood supply, mortality, surgery, therapy* Liver Regeneration / physiology* Male Neoplasm Staging Phlebography Portal Vein Preoperative Care / methods Risk Assessment Sensitivity and Specificity Survival Analysis Tomography, X-Ray Computed Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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