الفهرس | Only 14 pages are availabe for public view |
Abstract So, PVE is a safe and effective method for inducing selective hepatic hypertrophy in the appropriate clinical setting. This technique, usually reserved for those patients whose FLR is too small to allow safe resection, may reduce complications and shorten hospital stays after resection. (May & Madoff et al., 2012) The beauty of the reversible PVE is both the short term liver regeneration and the potential preservation of the embolized liver which may lead to great importance in clinical practice. If embolized liver recovers after recanalization, at least three clinical outcomes would be expected. First, reversible PVE would increase the possibilities of multi-step strategies in the surgical treatment of malignant bilobar tumours like colorectal metastases, in order to spare non tumoral liver parenchyma. Second, in the field of the basic research topic of the authors, reversible PVE would help to improve hepatocyte transplantation by providing a temporary window to improve the yield of hepatocyte engraftment in recipient liver. Finally, in living donor liver transplantation, why should it not be expected that reversible right PVE would allow hypertrophy of the future left liver graft in saving the right liver in the donor? Although, the functional recovery of the embolized liver after recanalization was not proven, the authors open a new field of future experimental research to investigate this hypothesis. (May & Madoff et al., 2012) In addition, the indications and contraindications for PVE, the methods for assessing hepatic lobar hypertrophy, the means of determining optimal timing of resection and the possible complications of PVE need to be fully understood before undertaking the procedure. Technique may vary among operators, and further research is necessary to determine the best embolic agents available and the expected rates of liver regeneration for PVE. Nevertheless, as hepatobiliary surgeons become more experienced at performing extended hepatic resections, PVE may be requested more frequently. (May & Madoff et al., 2012). |