1:30 PM Abstract No. 196 - Baseline left portal vein and left liver lobe size predicts hypertrophy of the left liver lobe after right portal vein embolization

Abstract

Purpose Postoperative liver failure is a concern for patients who undergo partial hepatectomy for malignant liver lesions. Selective portal vein embolization (PVE) aims to increase the volume of the future liver remnant prior to resection. Hypertrophy of the non-malignant segments of liver following PVE is variable. Our objective was to determine whether baseline portal vein and liver size assessed on computed tomography (CT) can predict the degree of hypertrophy of the liver lobe following PVE. Materials and Methods A retrospective cohort study of adult patients who underwent right PVE prior to partial hepatectomy at a single university hospital was undertaken. Patients who had prior resections, prior embolization, had left portal vein or bilateral selective embolization were excluded. Patients were identified from the liver cancer database and PACS. All patients had a CT scan before and after PVE. The cross-sectional area of the main and left portal veins on pre and post-embolization CT were assessed within 1cm of the bifurcation. Volumetric measurements of the left liver lobe on all pre and post-embolization scans was performed. The left lobe was defined as segments 1, 2, 3, 4a and 4b. Data was analysed by linear regression and is expressed as mean (SD) or as stated. Results Fifty-four patients who met our inclusion criteria underwent first time PVE between 2004 and 2011. Fifty-one (94%) patients had colorectal metastases and the mean age of patients was 61 (10) years. The mean time from baseline CT to PVE was 55 (40.5) days and from PVE to post-embolisation CT was 27 (15.5) days. Baseline left portal vein and left liver lobe size were the only significant predictors of post PVE left liver lobe hypertrophy. Every mm 2 increase in baseline left portal vein diameter predicted a 2 cm 3 increase in post PVE left liver lobe size (B = 2.02) (SE: 0.82, p = 0.017). Conversely every cm 3 increase in baseline left liver lobe size predicted a 0.05% reduction in percent increase of left liver lobe size post PVE (B = −0.05) (SE: 0.02, p = 0.002). Conclusion Baseline left portal vein and left liver lobe size predicts post PVE left lobe size in this small cohort. Our findings require validation in larger cohorts derived from multiple centres.