Liver venous deprivation is superior to portal vein embolization to induce future remnant liver hypertrophy before major hepatectomy: A single center experience.

Abstract

Background: To assess the safety and efficacy of liver venous deprivation (simultaneous hepatic vein embolization (HVE) with portal vein embolization (PVE)) compared to PVE only before major hepatectomy in patients with too small future remnant liver (FRL). Material & Methods: All consecutive patients who underwent ipsilateral liver venous deprivation (LVD) before major hepatectomy (>4 Couinauds' segments) at the University Hospital CHUV from 2016 to 2018 were assessed. In order to analyse the safety and efficacy of LVD, post embolization, postoperative outcomes and volumetric analysis were compared with patients who underwent PVE alone (PVE group) from 2010 to 2016. FRL hypertrophy was calculated by two validated formulas and liver volumetry was performed by 2 different observers (1 surgeon and 1 radiologist). Results: During the study period, 18 patients underwent LVD and 50 PVE. In the PVE vs. LVD groups, dropout rate was 40% vs. 0% due to disease progression, respectively. Median time from embolization to surgery was 36 days (range: 23-109 days) after LVD vs. 35 days (range: 20-181 days) after PVE (p=0.924).There was no significant difference in the operative time, estimated blood loss, morbidity rate, median length of hospital stay and mortalitybetween the two groups. FRL hypertrophy was significantly higher in the LVD group (median; 135%, range: 112%-232%) than in the PVE group (median; 124%, range: 98%-203%) (p=0.039) in a median of 25 days (23 days after LVD, 26 days after PVE) after embolization. FRL hypertrophy analysis less than 21 days after embolization showed that degree of hypertrophy was significantly higher in the LVD group (n=7, median; 136%, range: 112%-168%) than in the PVE group (n=10, median; 112%, range: 98%-148%) (p=0.011). Conclusions Ipsilateral liver venous deprivation before major hepatectomy is safe and induces a higher and faster FRL hypertrophy than after PVE only.