Abstract
Abstract Background Liver venous deprivation (LVD) is a recently developed method to reach maximal liver hypertrophy before major hepatectomy. LVD combines simultaneous portal and ipsilateral hepatic vein embolization. An international registry was created in 2021. Aims This study aimed to describe the outcomes after LVD of patients included in the registry. Methods Since its creation, 7 international expert HPB centers participated to the registry. Preoperative characteristics, data on liver regeneration after LVD, and postoperative results after hepatectomy were collected. Future liver remnant (FLR) and standardized FLR ratios were defined as FLR/total functional liver volume and FLR/total estimated liver volume. Results A total of 191 patients were included (71 women). Median age was 63 (IQR 53-69) and body-mass index 24.8 kg/m2 (IQR 22.3-28.7). Fifty-three patients were ASA III/IV. Main surgical indication was colorectal metastases (n=116). Median FLR and standardized FLR ratios before LVD were 33% (IQR 26-47) and 32% (IQR 23-39). Median time for the LVD procedure was 122 minutes (IQR 99-164). In one patient right hepatic vein embolization failed. Complications after LVD occurred in 14 patients (7%), including 7 hemorrhages/hematomas. After LVD, median FLR and standardized FLR ratios significantly increased to 46% (IQR 39-59, p<0.001) and 44% (IQR 35-50, p<0.001), corresponding to a median kinetic growth rate of 3.2%/week (IQR 1.6-5.3). Hepatectomy was performed in 142 patients (69 extended hepatectomies), while 49 dropped out (7 for insufficient hypertrophy (4%), 27 for tumor progression (14%), and 15 for other reasons (8%)). Seventy-one patients had postoperative complications (50%), and only 2 developed postoperative liver failure (1%). Median Comprehensive Complication Index was 20.9 (IQR 0-30.8) and 10 patients were reoperated (7%). Conclusion The preliminary data of this international registry showed that LVD had a high technical success rate (190/191) with few post-procedural complications and significant kinetic growth. Major hepatectomy after LVD appeared to be safe.
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