Abstract
Objectives Portal vein embolization (PVE) stimulates hypertrophy of the future liver remnant (FLR) and improves the safety of extended hepatectomy. This study evaluated the efficacy of PVE, performed with PVA and coils, in relation to its effect on FLR volume and ratio. Secondary endpoints were the assessment of PVE complications, accomplishment of liver surgery, and patient outcome after hepatectomy. Materials and Methods All patients who underwent PVE before planned major hepatectomy between 2013 and 2017 were retrospectively analyzed, comprising a total of 64 patients. Baseline patient clinical characteristics, imaging records, liver volumetric changes, complications, and outcomes were analyzed. Results There were 45 men and 19 women with a mean age of 64 years. Colorectal liver metastasis was the most frequent liver tumor. The majority of patients (n = 53) had a right PVE. FLR increased from a mean value of 484 ml ± 242 to 654 ml ± 287 (p < 0.001) after PVE. Two major complications were experienced after PVE: 1 case of left hepatic artery branch laceration and 1 case of hemoperitoneum and hemothorax. A total of 44 (69%) patients underwent liver surgery. Twenty-one patients were not taken to surgery due to disease progression (n = 18), liver insufficiency (n = 1), and insufficient FLR volume (n = 1), and one patient declined surgery (n = 1). Conclusions PVE with PVA and coils was accomplished safely and promoted a high FLR hypertrophy yield, enabling most of our patients to be submitted to the potentially curative treatment of liver tumor resection.
Highlights
Liver resection of hepatic tumors is the firstline treatment option for curative intent in hepatic malignancies, and in order to accomplish free surgical margins, an extended hepatectomy is required up until 45% of liver tumors [1]
future liver remnant (FLR) increased from a mean value of 484 ml ± 242 to 654 ml ± 287 (p < 0.001) after portal vein embolization (PVE), corresponding to a mean FLR increase of 40% ± 29% and a mean FLR/total functional liver volume (TFLV) ratio increase of 11% ± 5%. e TFLV increased from 1399 ± 347 to 1428 ± 380 after PVE (Figure 3)
Laboratory data, regarding total bilirubin, Aspartate aminotransferase international normalized ratio (INR) (AST), and INR before PVE and before surgery, were 1.41 ± 2.37 and 2.08 ± 5.24; 40 ± 23.63 and 55.94 ± 76; 1.07 ± 0.15 and 1.22 ± 0.45, respectively. ere was an inverse relation between the FLR volume before PVE and FLR volume increase induced by PVE (Figure 4)
Summary
Liver resection of hepatic tumors is the firstline treatment option for curative intent in hepatic malignancies, and in order to accomplish free surgical margins, an extended hepatectomy is required up until 45% of liver tumors [1]. The main cause for not performing the planned hepatic resection is inadequate future liver remnant (FLR) volume before surgery. FLR size must be optimized to prevent postoperative liver failure (PLF), the principal cause of postoperative death after major hepatectomy [2]. In order to extend the indications of main hepatic resection and to prevent PLF, preoperative portal vein embolization (PVE) has been performed through the last decades, allowing atrophy of the future resected liver segments and hypertrophy of the FLR [3, 4]. PVE has a high technical success rate approaching 100% in most
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