2:42 PM Abstract No. 205 - Portal vein embolization for two-stage hepatectomy in patients with colorectal liver metastasis: safety, efficacy, and value of including segment 4

Abstract

Purpose To examine the efficacy and safety of portal vein embolization (PVE) on future liver remnant (FLR) hypertrophy when used between the first and second stage of two-stage hepatectomy (TSH) in patients with colorectal liver metastases (CLM). Secondary purpose was to evaluate the effect of extending right portal vein embolization (RPVE) to segment 4 (RPVE + 4) on hypertrophy of segments 2 + 3 (S2 + 3). Materials and Methods IRB-approved retrospective cohort study performed from May 1998 to January 2011. Fifty-one patients with CLM underwent PVE as an adjunct to TSH; RPVE was performed in 16 and RPVE + 4 was performed in 35. Absolute FLR volumes, standardized future liver remnant (sFLR) ratios, degree of hypertrophy (DH), and complications were recorded and analyzed with t-tests. To assess the value of extending RPVE to segment 4 in the setting of TSH, absolute volumes and DH were measured for S2 + 3 for all 51 TSH patients. All volumetric measurements were compared to a control cohort composed of 96 patients (n = 37 RPVE, n = 59 RPVE + 4) in whom PVE was performed as an adjunct to single stage hepatectomy (SSH) during the same time period. Results For patients who completed RPVE as an adjunct to TSH (n = 16/16), absolute FLR volume increased from 268.3 mL to 427.3 mL (p Conclusion PVE is an effective and safe technique to induce a significant DH in the FLR prior to definitive stage 2 hepatectomy. Unlike SSH, extending RPVE to RPVE + 4 for TSH does not appear to induce a significant hypertrophy of S2 + 3 volumes.