Safety and efficacy of combined portal and hepatic vein embolisation in patients with colorectal liver metastases (DRAGON1): a multicentre, single-arm clinical trial.
[en] [en] BACKGROUND: Major liver resection is often required for complete clearance of colorectal liver metastases (CRLM). Patients with insufficient future liver remnant (FLR) volume/function are at high risk of post-hepatectomy liver failure (PHLF) and require FLR hypertrophy-inducing procedures to enable safe resection. The most recent variant of these procedures is combined portal and hepatic vein embolization (PVE/HVE). The DRAGON 1 trial evaluates the safety and efficacy of PVE/HVE, while assessing recruitment potential for the DRAGON 2 randomized trial.
METHODS: DRAGON 1 is a prospective, single-arm, international, multicenter trial. Patients with upfront unresectable CRLM due to a small FLR were included. The primary outcome was the ability of centers to recruit three patients and perform PVE/HVE and liver resection without 90-day mortality. Secondary outcomes included recruitment capacity, PVE/HVE technical details, FLR volume changes, complications, and resection rates. The study is registered at ClinicalTrials.gov, identifier: NCT04272931.
FINDINGS: In total, 102 patients were included from 43 centers. Twenty-four centers (24/43 = 56%) recruited three or more patients, and 20 centers (20/43 = 47%) achieved this without 90-day mortality. Of 96 patients undergoing PVE/HVE, no post-embolization mortality occurred, though major complications were reported in two patients. Resection was completed in 86 patients (86/96 = 90%), with seven patients (7/86 = 8%) dying within 90 days. PHLF grade B/C (International Study Group of Liver Surgery criteria) occurred in 19 patients (19/86 = 22%).
INTERPRETATION: DRAGON 1 demonstrates that PVE/HVE is safe, with no embolization-related mortality, low morbidity, and high resection rates in upfront unresectable CRLM.
FUNDING: The Dutch Cancer Society, National Institute for Health and Care Research UK, Maastricht UMC+, Abbott Laboratories and Guerbet.
Disciplines :
Surgery
Author, co-author :
Korenblik, Remon ; Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands ; GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands
James, Sinéad ; Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands ; GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands
Smits, Jens; Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands ; GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands
Díaz-Nieto, Rafael; Department of Liver Surgery, Liverpool University Hospitals NHS, Lower Ln, Fazakerley, Liverpool, L9 7AL, UK
Davis, Rob; Department of Interventional Radiology, Liverpool University Hospitals NHS, Lower Ln, Fazakerley, Liverpool, L9 7AL, UK
Chan, Benjamin K Y; Department of Liver Surgery, Liverpool University Hospitals NHS, Lower Ln, Fazakerley, Liverpool, L9 7AL, UK
Erdmann, Joris I; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
Zijlstra, IJsbrand A J; Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
Arntz, Pieter J W; Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
Kollmar, Otto; Department of Surgery, Clarunis University Hospital, Surgery, Kleinriehenstrasse 30, 4058, Basel, Switzerland
Hoffmann, Martin H; Department of Radiology, St. Claraspital, Kleinriehenstrasse 30, 4058, Basel, Switzerland
Vass, David G; Department of Surgery, Belfast Health & Social Care Trust, 51 Lisburn Rd, Belfast, BT9 7AB, UK
Lindsay, Richard; Department of Interventional Radiology, Belfast Health & Social Care Trust, 51 Lisburn Rd, Belfast, BT9 7AB, UK
Serenari, Matteo; Hepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, BO, Italy ; Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, 40126, Bologna, BO, Italy
Cappelli, Alberto; Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Zamboni, 33, 40126, Bologna, BO, Italy
Gobardhan, Paul D; Department of Surgery, Amphia, Molengracht 21, 4818 CK, Breda, the Netherlands
Imani, Farshad; Department of Radiology, Amphia Molengracht 21, 4818 CK, Breda, the Netherlands
Suarez, Yiliam Fundora ; Department of Surgery, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
Muños, Fernando Gómez; Department of Radiology, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain
Grünhagen, Dirk J; Department of Surgery, Erasmus Medisch Centrum, Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
Moelker, Adriaan; Department of Radiology and Nuclear Medicine, Erasmus MC, Erasmus University, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
Pieterman, Kay J; Department of Radiology and Nuclear Medicine, Erasmus MC, Erasmus University, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
Kleeff, Jörg; Department of Surgery, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany
Wohlgemuth, Walter A; Department of Radiology, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany
Herrero, Eric; Department of Surgery, University Hospital Mútua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
Gelabert, Arantxa ; Department of Radiology, Hospital Parc Taulí de Sabadell, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain ; Department of Radiology, University Hospital Mútua Terassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
Breitenstein, Stefan; Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
Seeger, Nico ; Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
Detry, Olivier ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne
GERARD, Laurent ; Centre Hospitalier Universitaire de Liège - CHU > > Service médical de radiodiagnostic
Sandström, Per A; Department of Surgery, Linköping University Hospital, Universitetssjukhuset, 581 85, Linköping, Sweden
Björnsson, Bergthor; Department of Surgery, Linköping University Hospital, Universitetssjukhuset, 581 85, Linköping, Sweden
Aldrighetti, Luca A; Department of Surgery, Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
De Cobelli, Francesco; Department of Radiology, Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
Leclercq, Wouter K G ; Department of Surgery, Máxima Medisch Centrum, De Run 4600, 5504 DB, Veldhoven, the Netherlands
van Baardewijk, Laurens J; Department of Radiology, Máxima Medisch Centrum, De Run 4600, 5504 DB, Veldhoven, the Netherlands
Croagh, Daniel ; Department of Surgery, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia ; Monash University, Melbourne, Wellington Rd, Clayton, VIC, 3800, Australia
De Boo, Diederick W; Department of Radiology, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia ; Monash University, Melbourne, Wellington Rd, Clayton, VIC, 3800, Australia
Kingham, T Peter; Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
Ridouani, Fourat; Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
Metrakos, Peter; Department of Surgery, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
Valenti, David; Department of Radiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
Kalil, Jennifer ; Department of Surgery, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
Fretland, Åsmund A; Department of Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
Carling, Ulrik; Department of Radiology, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
Martel, Guillaume; Department of Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
Ryan, Stephen; Department of Radiology, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
Udupa, Venkatesha; Department of HPB Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
Macdonald, Andrew; Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
Tasse, Jordan C; Department of Interventional Radiology, Rush University Medical Center, 1620 W Harrison St, Chicago, IL, 60612, USA
Stavrou, Gregor A ; Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbruecken, Winterberg 1, 66119, Saarbrücken, Germany
Spuentrup, Elmar; Institute for Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Saarbruecken, Winterberg 1, 66119, Saarbrücken, Germany
Borobia, Francisco G; Department of Surgery, Hospital Parc Taulí de Sabadell, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
Criado, Eva; Interventional Radiology Unit, UDIAT-Centre Diagnòstic, Hospital Universitario Parc Tauli Sabadell, Medicine Department Universidad Autónoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
Sparrelid, Ernesto; Division of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Nobels väg 6, 171 77, Stockholm, Sweden
Delle, Martin; Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Nobels väg 6, 171 77, Stockholm, Sweden
Navinés-López, Jordi; Department of Surgery, University Hospital Germans Trias I Pujol, Ctra. de Canyet, s/n, 08916, Badalona, Barcelona, Spain
Moragues, Jaume Sampere; Department of Radiology, University Hospital Germans Trias I Pujol, Ctra. de Canyet, s/n, 08916, Badalona, Barcelona, Spain
Andorrà, Esteban Cugat; Department of Surgery, University Hospital Germans Trias I Pujol, Ctra. de Canyet, s/n, 08916, Badalona, Barcelona, Spain
Schnitzbauer, Andreas; Department of Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
Vogl, Thomas J; Department of Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
Heil, Jan; Department of Surgery, University of Ulm, Albert-Einstein-Allee 7, 89081, Ulm, Germany
Primrose, John N; University Surgery, University Hospital Southampton NHS Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
Modi, Sachin; Department of Radiology, University Hospital Southampton NHS Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
Fouraschen, Suomi M G; Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
Bokkers, Reinoud P H; Department of Radiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
de Boer, Marieke T; Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
Borel Rinkes, Inne H M; Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
Smits, Maarten L J; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
Gruenberger, Thomas; Department of Surgery, HPB Center, Clinic Favoriten, Health Network Vienna, Kundratstraße 3, 1100, Wien, Austria ; Sigmund Freud University Vienna, Freudplatz 1, 1020, Wien, Austria
Baclija, Ivan; Department of Radiology, Clinic Favoriten, Kundratstraße 3, 1100, Wien, Austria
Billingsley, Kevin G; Department of Surgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
Madoff, David C; Department of Radiology, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
Serrablo, Alejandro; Department of Surgery, University Hospital Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain
Sarriá, Luis; Department of Radiology, University Hospital Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain
Wang, Xiaoying; Department of Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Xuhui District, Shanghai, 200032, China
Xudong, Qu; Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Xuhui District, Shanghai, 200032, China
Winkens, Bjorn; Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
Olde Damink, Steven W L; Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
Bemelmans, Marc H A; Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
Dewulf, Maxime J L; Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
Binkert, Christoph A; Clinic of Interventional Radiology and Vascular Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
Schadde, Erik; Department of Surgery, Rush University Medical Center, 1620 W Harrison St, Chicago, IL, 60612, USA ; Chirurgie Zentrum, Hirslanden Klinik, St. Anna Luzern, St. Anna-Strasse 32, 6006, Luzern, Switzerland
van der Leij, Christiaan; GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands ; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
van Dam, Ronald M; Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands ; GROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands
Safety and efficacy of combined portal and hepatic vein embolisation in patients with colorectal liver metastases (DRAGON1): a multicentre, single-arm clinical trial.
CIHR - Canadian Institutes of Health Research CBS - Canadian Blood Services
Funding text :
The Dutch Cancer Society, National Institute for Health and Care Research UK, Maastricht UMC+, Abbott Laboratories and Guerbet.C.A. Binkert: research support from Abbott Laboratories; consulting fees from CTI Vascular, Biotronic (consulting on technology). \u00C5.A. Fretland: honoraria from Bayer, Angiodynamics, Medtronic (speaker). D.C. Madoff: Receipt of equipment from Abbott Laboratories (plugs), Guerbet (lipiodol), Boston Scientific (embolic particles) for pre-clinical animal studies; consulting fees from Guerbet, Boston Scientific (advisory board). G. Martel: unrelated research grants from Canadian Institutes of Health Research, Canadian Blood Services. R.M. van Dam: research grants and study materials from Abbott Laboratories, Guerbet.
Regimbeau, J.M., Cosse, C., Kaiser, G., et al. Feasibility, safety and efficacy of two-stage hepatectomy for bilobar liver metastases of colorectal cancer: a LiverMetSurvey analysis. HPB (Oxford) 19:5 (2017), 396–405.
Sandstrom, P., Rosok, B.I., Sparrelid, E., et al. ALPPS improves resectability compared with Conventional two-stage hepatectomy in patients with advanced colorectal liver metastasis: results from a scandinavian multicenter randomized controlled trial (LIGRO trial). Ann Surg 267:5 (2018), 833–840.
Passot, G., Chun, Y.S., Kopetz, S.E., et al. Predictors of safety and efficacy of 2-stage hepatectomy for bilateral colorectal liver metastases. J Am Coll Surg 223:1 (2016), 99–108.
Filmann, N., Walter, D., Schadde, E., et al. Mortality after liver surgery in Germany. Br J Surg 106:11 (2019), 1523–1529.
Wang, K., Liu, Y., Hao, M., et al. Clinical outcomes of parenchymal-sparing versus anatomic resection for colorectal liver metastases: a systematic review and meta-analysis. World J Surg Oncol, 21(1), 2023, 241.
Kishi, Y., Abdalla, E.K., Chun, Y.S., et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg 250:4 (2009), 540–548.
Shindoh, J., Truty, M.J., Aloia, T.A., et al. Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant. J Am Coll Surg 216:2 (2013), 201–209.
Arntz, P.J.W., Deroose, C.M., Marcus, C., et al. Joint EANM/SNMMI/IHPBA procedure guideline for [(99m)Tc]Tc-mebrofenin hepatobiliary scintigraphy SPECT/CT in the quantitative assessment of the future liver remnant function. HPB (Oxford) 25:10 (2023), 1131–1144.
Chaouch, M.A., Mazzotta, A., da Costa, A.C., et al. A systematic review and meta-analysis of liver venous deprivation versus portal vein embolization before hepatectomy: future liver volume, postoperative outcomes, and oncological safety. Front Med, 10, 2023, 1334661.
Korenblik, R., van Zon, J., Olij, B., et al. Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis. BJS Open, 6(6), 2022.
Le Roy, B., Gallon, A., Cauchy, F., et al. Combined biembolization induces higher hypertrophy than portal vein embolization before major liver resection. HPB (Oxford) 22:2 (2020), 298–305.
Heil, J., Korenblik, R., Heid, F., et al. Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis. Br J Surg, 2021.
Korenblik, R., Heil, J., Smits, J., et al. Liver regeneration after portal and hepatic vein embolization improves overall survival compared with portal vein embolization alone: mid-term survival analysis of the multicentre DRAGON 0 cohort. Br J Surg, 111(4), 2024.
Guiu, B., Chevallier, P., Denys, A., et al. Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol 26:12 (2016), 4259–4267.
Bell, R.J., Hakeem, A.R., Pandanaboyana, S., Davidson, B.R., Prasad, R.K., Dasari, B.V.M., Portal vein embolization versus dual vein embolization for management of the future liver remnant in patients undergoing major hepatectomy: meta-analysis. BJS Open, 6(6), 2022.
Korenblik, R., Olij, B., Aldrighetti, L.A., et al. Dragon 1 protocol Manuscript: training, accreditation, implementation and safety evaluation of portal and hepatic vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy. Cardiovasc Interv Radiol, 2022.
Eisenhauer, E.A., Therasse, P., Bogaerts, J., et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:2 (2009), 228–247.
Vandenbroucke, J.P., von Elm, E., Altman, D.G., et al. Strengthening the reporting of observational studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 12:12 (2014), 1500–1524.
World Medical, A., World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ 79:4 (2001), 373–374.
Najafi, A., Schadde, E., Binkert, C.A., Combined simultaneous embolization of the portal vein and hepatic vein (double vein embolization) - a technical note about embolization sequence. CVIR Endovasc, 4(1), 2021, 43.
Vauthey, J.N., Abdalla, E.K., Doherty, D.A., et al. Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 8:3 (2002), 233–240.
Strasberg, S.M., Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:5 (2005), 351–355.
Dindo, D., Demartines, N., Clavien, P.A., Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:2 (2004), 205–213.
Rahbari, N.N., Garden, O.J., Padbury, R., et al. Posthepatectomy liver failure: a definition and grading by the international study group of liver surgery (ISGLS). Surgery 149:5 (2011), 713–724.
Shindoh, J., Tzeng, C.W., Aloia, T.A., et al. Safety and efficacy of portal vein embolization before planned major or extended hepatectomy: an institutional experience of 358 patients. J Gastrointest Surg 18:1 (2014), 45–51.
Guiu, B., Quenet, F., Panaro, F., et al. Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes. Hepatobiliary Surg Nutr 9:5 (2020), 564–576.
Fichtinger, R.S., Aldrighetti, L.A., Abu Hilal, M., et al. Laparoscopic versus open hemihepatectomy: the ORANGE II PLUS multicenter randomized controlled trial. J Clin Oncol 42:15 (2024), 1799–1809.
Magnin, J., Bernard, A., Cottenet, J., et al. Impact of hospital volume in liver surgery on postoperative mortality and morbidity: nationwide study. Br J Surg 110:4 (2023), 441–448.
van Keulen, A.M., Buettner, S., Erdmann, J.I., et al. Multivariable prediction model for both 90-day mortality and long-term survival for individual patients with perihilar cholangiocarcinoma: does the predicted survival justify the surgical risk?. Br J Surg 110:5 (2023), 599–605.
Chapelle, T., Op De Beeck, B., Huyghe, I., et al. Future remnant liver function estimated by combining liver volumetry on magnetic resonance imaging with total liver function on (99m)Tc-mebrofenin hepatobiliary scintigraphy: can this tool predict post-hepatectomy liver failure?. HPB (Oxford) 18:6 (2016), 494–503.
Una-Gorospe, J.A., Determination of the segmental hepatic clearance rate of (99m)Tc-mebrofenin and its application in the functional assessment of future liver remnant after liver resection. Rev Esp Med Nucl Imagen Mol 40:6 (2021), 385–396.
Chebaro, A., Buc, E., Durin, T., et al. Liver venous deprivation or associating liver partition and portal vein ligation for staged hepatectomy?: a retrospective multicentric study. Ann Surg 274:5 (2021), 874–880.
Ghosn, M., Kingham, T.P., Ridouani, F., et al. Percutaneous liver venous deprivation: outcomes in heavily pretreated metastatic colorectal cancer patients. HPB (Oxford) 24:3 (2022), 404–412.
Kobayashi, K., Yamaguchi, T., Denys, A., et al. Liver venous deprivation compared to portal vein embolization to induce hypertrophy of the future liver remnant before major hepatectomy: a single center experience. Surgery 167:6 (2020), 917–923.
