A predictive scoring system for insufficient liver hypertrophy after preoperative portal vein embolization

Abstract

Background: The factors affecting hypertrophy of the future liver remnant (FLR) after portal vein embolization (PVE) remain unclear. The aim of this study was to clarify the clinical factors affecting the hypertrophy rate after PVE and to develop a scoring system predicting insufficient liver hypertrophy. Methods: A total of 152 patients who underwent PVE of the right portal branch between 2006 and 2016 were reviewed retrospectively. The score to predict insufficient (<25%) hypertrophy was established based on logistic regression analyses of the clinical parameters before PVE. Results: After PVE, the FLR volume significantly increased from 364 (151–801) ml, 33.3% (17.9%–53.8%) to 451 (242–866) ml, 41.9% (26.1%–65.1%). The median hypertrophy rate was 23.9% (−5.1%–95.5%). A preoperative predictive scoring system for insufficient liver hypertrophy was constructed using the following 4 factors; an initial FLR volume ≥35% (2 points), alkaline phosphatase ≥450 IU/dL (1 point), cholinesterase <220 mg/dL (1 point), and the indocyanine green disappearance rate <0.16 (1 point). The constructed scoring system showed the proportion of patients with insufficient liver hypertrophy (<25%) to be 1/22 (4.5%) in the low-score group (0 point), 33/75 (44.0%) in the medium-score group (1–2 points), and 46/55 (83.6%) in the high-score group (3–5 points). The hypertrophy rate of FLR was significantly different among the 3 groups (low-score group, 40.1% [2.1–73.2%]; medium-score group, 26.5% [−5.1–81.4%]; high-score group, 20.1% [1.1–49.8%]) (P < 0.001). Conclusion: The constructed scoring system was able to stratify patients before PVE according to the possibility of developing insufficient liver hypertrophy.