Radioembolization versus portal vein embolization for contralateral liver lobe hypertrophy: effect of cirrhosis

Heiner Nebelung,Carina Riediger,Thomas Wolf,Christoph Georg Radosa,Jens-Peter Kühn,Verena Plodeck,Sabine Grosche-Schlee,Sebastian Bund,Ralf-Thorsten Hoffmann

doi:10.1007/s00261-021-03048-1

Abstract

PurposePreoperative hypertrophy induction of future liver remnant (FLR) reduces the risk of postoperative liver insufficiency after partial hepatectomy. One of the most commonly used methods to induce hypertrophy of FLR is portal vein embolization (PVE). Recent studies have shown that transarterial radioembolization (TARE) also induces hypertrophy of the contralateral liver lobe. The aim of our study was to evaluate contralateral hypertrophy after TARE versus after PVE taking into account the effect of cirrhosis.MethodsForty-nine patients undergoing PVE before hemihepatectomy and 24 patients with TARE as palliative treatment for liver malignancy were retrospectively included. Semi-automated volumetry of the FLR/contralateral liver lobe before and after intervention (20 to 65 days) was performed on CT or MRI, and the relative increase in volume was calculated. Cirrhosis was evaluated independently by two radiologists on CT/MRI, and interrater reliability was calculated.ResultsHypertrophy after PVE was significantly more pronounced than after TARE (25.3% vs. 7.4%; p < 0.001). In the subgroup of patients without cirrhosis, the difference was also statistically significant (25.9% vs. 8.6%; p = 0.002), whereas in patients with cirrhosis, the difference was not statistically significant (18.2% vs. 7.4%; p = 0.212). After PVE, hypertrophy in patients without cirrhosis was more pronounced than in patients with cirrhosis (25.9% vs. 18.2%; p = 0.203), while after TARE, hypertrophy was comparable in patients with and without cirrhosis (7.4% vs. 8.6%; p = 0.928).ConclusionTARE induces less pronounced hypertrophy of the FLR compared to PVE. Cirrhosis seems to be less of a limiting factor for hypertrophy after TARE, compared to PVE.Graphic abstract

Highlights

Partial hepatectomy is frequently the curative treatment of choice for malignant tumors of the liver
In the subgroup of patients without cirrhosis, hypertrophy after portal vein embolization (PVE) was significantly more pronounced than after transarterial radioembolization (TARE) [25.9% (IQR 29.8%) vs. 8.6% (IQR 12.8%); p = 0.002], whereas time intervals were similar to the overall study population [32 days (IQR 15 days) vs. 46 days (IQR 24 days)]
Our study shows that PVE leads to significantly more pronounced hypertrophy of the future liver remnant (FLR) in a shorter time interval than TARE, in patients without cirrhosis

Summary

Introduction

Partial hepatectomy is frequently the curative treatment of choice for malignant tumors of the liver. Location, and number of lesions, extensive resections up to extended hemihepatectomy can be necessary. Resection of more than 75% of hepatic parenchyma more than triples the risk of postoperative hepatic dysfunction [1]. Preoperative hypertrophy induction of the future liver remnant (FLR) can lead to an increase in functioning liver parenchyma and, reduces the risk of postoperative liver insufficiency. The currently best-studied methods to induce hypertrophy of FLR are portal vein embolization (PVE) and portal vein ligation [2, 3], which is often combined with partition of liver parenchyma (“in situ split”) [4]. Recent studies have shown that transarterial radioembolization (TARE) induces hypertrophy of the contralateral, untreated liver lobe [5,6,7]

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