{"title":"年龄对肝门周围胆管癌肝切除术门静脉栓塞术后肝储备的影响。","authors":"Shinichi Nakanuma, Takahiro Ogi, Hiroaki Sugita, Ryosuke Gabata, Tomokazu Tokoro, Ryohei Takei, Kaichiro Kato, Satoshi Takada, Mitsuyoshi Okazaki, Isamu Makino, Shintaro Yagi","doi":"10.1016/j.asjsur.2024.10.152","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>In the current situation of an increasing older adult population with perihilar cholangiocarcinoma (PHCC), the benefits and risks of surgical treatment of PHCC in older people remain controversial. Portal vein embolization (PVE) is a useful preoperative procedure to improve hepatic reserve in the future remnant liver (FRL) and avoid postoperative liver failure after extended hepatectomy for PHCC. This study aimed to evaluate the influence of aging on PVE.</p><p><strong>Methods: </strong>We enrolled 25 patients who underwent right hepatectomy with percutaneous transhepatic PVE. Participants aged <70 years (n = 13) and ≥70 years (n = 12) were compared; correlation coefficients were evaluated using all cases. The FRL volume/total liver volume (FRLV/TLV) ratio and the indocyanine green (ICG) clearance rate (ICG-K) fraction of FRL to total liver (ICG-Krem) were analyzed as FRL hepatic reserves.</p><p><strong>Results: </strong>FRLV/TLV ratio increased after PVE in <70 years and ≥70 years groups (p = 0.002 and p = 0.013, respectively). The change in ICG-K values from before to after PVE varied between both groups (p = 0.040). The ICG-Krem value after PVE increased only in the <70 years group (p = 0.009). A review of all cases showed a negative correlation between the change (after - before PVE) in the ICG-K and ICG-Krem values and age (r = -0.4827, p = 0.0145 and r = -0.4328, p = 0.0306, respectively).</p><p><strong>Conclusions: </strong>This study showed aging suppresses hepatic reserve improvement in the FRL, particularly in ICG clearance after PVE in PHCC cases.</p>","PeriodicalId":55454,"journal":{"name":"Asian Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":3.5000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of aging on hepatic reserve after preoperative portal vein embolization in hepatectomy for perihilar cholangiocarcinoma.\",\"authors\":\"Shinichi Nakanuma, Takahiro Ogi, Hiroaki Sugita, Ryosuke Gabata, Tomokazu Tokoro, Ryohei Takei, Kaichiro Kato, Satoshi Takada, Mitsuyoshi Okazaki, Isamu Makino, Shintaro Yagi\",\"doi\":\"10.1016/j.asjsur.2024.10.152\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>In the current situation of an increasing older adult population with perihilar cholangiocarcinoma (PHCC), the benefits and risks of surgical treatment of PHCC in older people remain controversial. Portal vein embolization (PVE) is a useful preoperative procedure to improve hepatic reserve in the future remnant liver (FRL) and avoid postoperative liver failure after extended hepatectomy for PHCC. This study aimed to evaluate the influence of aging on PVE.</p><p><strong>Methods: </strong>We enrolled 25 patients who underwent right hepatectomy with percutaneous transhepatic PVE. Participants aged <70 years (n = 13) and ≥70 years (n = 12) were compared; correlation coefficients were evaluated using all cases. The FRL volume/total liver volume (FRLV/TLV) ratio and the indocyanine green (ICG) clearance rate (ICG-K) fraction of FRL to total liver (ICG-Krem) were analyzed as FRL hepatic reserves.</p><p><strong>Results: </strong>FRLV/TLV ratio increased after PVE in <70 years and ≥70 years groups (p = 0.002 and p = 0.013, respectively). The change in ICG-K values from before to after PVE varied between both groups (p = 0.040). The ICG-Krem value after PVE increased only in the <70 years group (p = 0.009). A review of all cases showed a negative correlation between the change (after - before PVE) in the ICG-K and ICG-Krem values and age (r = -0.4827, p = 0.0145 and r = -0.4328, p = 0.0306, respectively).</p><p><strong>Conclusions: </strong>This study showed aging suppresses hepatic reserve improvement in the FRL, particularly in ICG clearance after PVE in PHCC cases.</p>\",\"PeriodicalId\":55454,\"journal\":{\"name\":\"Asian Journal of Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2024-12-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Journal of Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.asjsur.2024.10.152\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.asjsur.2024.10.152","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Impact of aging on hepatic reserve after preoperative portal vein embolization in hepatectomy for perihilar cholangiocarcinoma.
Purpose: In the current situation of an increasing older adult population with perihilar cholangiocarcinoma (PHCC), the benefits and risks of surgical treatment of PHCC in older people remain controversial. Portal vein embolization (PVE) is a useful preoperative procedure to improve hepatic reserve in the future remnant liver (FRL) and avoid postoperative liver failure after extended hepatectomy for PHCC. This study aimed to evaluate the influence of aging on PVE.
Methods: We enrolled 25 patients who underwent right hepatectomy with percutaneous transhepatic PVE. Participants aged <70 years (n = 13) and ≥70 years (n = 12) were compared; correlation coefficients were evaluated using all cases. The FRL volume/total liver volume (FRLV/TLV) ratio and the indocyanine green (ICG) clearance rate (ICG-K) fraction of FRL to total liver (ICG-Krem) were analyzed as FRL hepatic reserves.
Results: FRLV/TLV ratio increased after PVE in <70 years and ≥70 years groups (p = 0.002 and p = 0.013, respectively). The change in ICG-K values from before to after PVE varied between both groups (p = 0.040). The ICG-Krem value after PVE increased only in the <70 years group (p = 0.009). A review of all cases showed a negative correlation between the change (after - before PVE) in the ICG-K and ICG-Krem values and age (r = -0.4827, p = 0.0145 and r = -0.4328, p = 0.0306, respectively).
Conclusions: This study showed aging suppresses hepatic reserve improvement in the FRL, particularly in ICG clearance after PVE in PHCC cases.
期刊介绍：
Asian Journal of Surgery, launched in 1978, is the official peer-reviewed open access journal of the Asian Surgical Association, the Taiwan Robotic Surgery Association, and the Taiwan Society of Coloproctology. The Journal is published monthly by Elsevier and is indexed in SCIE, Medline, ScienceDirect, Scopus, Embase, Current Contents, PubMed, Current Abstracts, BioEngineering Abstracts, SIIC Data Bases, CAB Abstracts, and CAB Health.
ASJSUR has a growing reputation as an important medium for the dissemination of cutting-edge developments in surgery and its related disciplines in the Asia-Pacific region and beyond. Studies on state-of-the-art surgical innovations across the entire spectrum of clinical and experimental surgery are particularly welcome.
The journal publishes original articles, review articles, and case reports that are of exceptional and unique importance. The journal publishes original articles, review articles, and case reports that are of exceptional and unique importance.
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