Ipsilateral access portal venous embolization (PVE) for preoperative hypertrophy exhibits low complication rates in Clavien-Dindo and CIRSE scales

Roland Brüning,Tim Reese,Michel Tiede,Martin Schneider,Axel Stang,Gregor Stavrou,Peter Wohlmuth,Thomas Von Hahn,Andrea Ehrenfeld,Georgios Makridis,Karl J Oldhafer

doi:10.1186/s42155-021-00227-5

Abstract

BackgroundPortal venous embolization (PVE) is a minimal invasive preoperative strategy that aims to increase future liver remnant (FLR) in order to facilitate extended hemihepatectomy. We analyzed our data retrospectively regarding complications and degree of hypertrophy (DH).Methods: 88 patients received PVE either by particles / coils (n = 77) or by glue / oil (n = 11), supported by 7 right hepatic vein embolizations (HVE) by coils or occluders. All complications were categorized by the Clavien- Dindo (CD) and the CIRSE classification.ResultsIn 88 patients (median age 68 years) there was one intervention with a biliary leak and subsequent drainage (complication grade 3 CD, CIRSE 3), two with prolonged hospital stay (grade 2 CD, grade 3 CIRSE) and 13 complications grade 1 CD, but no complications of grade 4 or higher neither in Clavien- Dindo nor in CIRSE classification. The median relative increase in FLR was 47% (SD 35%). The mean pre-intervention standardized FLR rose from 23% (SD 10%) to a post-intervention standardized FLR of 32% (SD 12%). The degree of hypertrophy (DH) was 9,3% (SD 5,2%) and the kinetic growth rate (KGR) per week was 2,06 (SD 1,84).ConclusionPVE and, if necessary, additional sequential HVE were safe procedures with a low rate of complications and facilitated sufficient preoperative hypertrophy of the future liver remnant.

Highlights

Portal venous embolization (PVE) is a minimal invasive preoperative strategy that aims to increase future liver remnant (FLR) in order to facilitate extended hemihepatectomy
If the proportion of the anticipated liver volume that remains in situ after surgery (the future liver remnant (FLR)) is small, patients remain at risk
Disease had to be liver dominant, and a tumor board vote had to be positive towards a hypertrophy model and hemihepatectomy

Summary

Introduction

Portal venous embolization (PVE) is a minimal invasive preoperative strategy that aims to increase future liver remnant (FLR) in order to facilitate extended hemihepatectomy. Recent advances in hepatobiliary surgery and the possibility of safely removing larger portions of the liver have improved the proportion of potentially resectable tumors in malignant liver disease (Abulkhir et al 2008). If the proportion of the anticipated liver volume that remains in situ after surgery (the future liver remnant (FLR)) is small, patients remain at risk (2021) 4:41 nonembolized /nontreated segments that will remain after resection (Madoff et al 2016). An increased FLR volume once archived helps patients previously considered ineligible for resection (Abulkhir et al 2008; Azoulay et al 2000; Madoff et al 2005). There is consensus that the necessary future liver volume is in the range of 25–40% and mainly depends on the quality of liver tissue (Abdalla et al 2002; Benson 3rd et al 2013; Kubota et al 1997; Shirabe et al 1999; de Meijer et al 2010), and on the underlying disease and histology

Methods

Results

Conclusion