மருத்துவ புற்றுநோயியல்: வழக்கு அறிக்கைகள்

Liver Venous Deprivation for Rapid Liver Hypertrophy before major Hepatectomy: A Case Report

Nathan John, Lisandro Montorfano, Arun Nagarajan, Conrad Simpfendorfer, Parag Amin and Mayank Roy

Liver Venous Deprivation (LVD) is an emerging minimally invasive strategy to induce rapid liver hypertrophy of the Future Liver Remnant (FLR) before a major hepatectomy. LVD (aka “double vein embolization”) entails same-session percutaneous embolization of the portal and hepatic veins of the planned liver resection. This report discusses the utilization and technical challenges of LVD in managing of a 49-year-old male with recurrent multifocal Colorectal Liver Metastases (CRLM). The patient initially underwent neoadjuvant FOLFOX chemotherapy followed by a simultaneous laparoscopic sigmoid colectomy and liver surgery (microwave ablation of segment 5^th, and wedge resections of segment 1^st and 4^thb), followed by completion of chemotherapy. The patient had a R0 resection with clear colon and liver surgical margins. Nine months after the initial surgery, the patient had a rise in tumor markers, and surveillance imaging demonstrated recurrence of liver metastases in segments 1^st and 5^th. LVD was performed by interventional radiology, which led to 28% increase in FLR (segments 2^nd, 3^rd, and 4^th); initially measuring 464 cm3 prior to LVD and measuring 594 cm3 by post-procedure day 21. The patient underwent right hemi-hepatectomy and caudate resection on post-procedure day 29. The patient did not have any complication and discharged on postoperative day six. The patient remains disease-free with no evidence of recurrence at twelve months follow up.