The alcohol injection into portal vein prior to ligation increases hepatic regeneration rate

Abstract

Introduction: The failure of portal vein ligation (PVL) to induce adequate hypertrophy might be owing to the formation of intrahepatic portoportal collaterals. The impact of alcohol injection into the portal vein prior to ligation is unknown. Aim of the study was to compare liver regeneration rate following PVL with (Alc+) and without (Alc−) simultaneous intraportal alcohol injection. Methods: The study population included all patients affected by colorectal liver metastases (CRLM) scheduled for portal vein ligation between 01/2004 and 06/2014. Since 09/2011 we associated the injection of absolute alcohol into the right portal vein prior to ligation. Data concerning future remnant liver volume (FLRV) pre and post PVL were analyzed. The FLRV as assessed by volumetric CT-scan. Liver regeneration was assessed by Volumetric Increase VI = [(FLRVpost% – FLRVpre%)/FLRVpre%]. Results: A total of 42 patients were considered: 23 in Alc+ group and 19 in Alc− group. The two groups were similar in terms of age, sex, diabetes, FLRV before PVL and administration of chemotherapy. Alcohol injection was feasible in every case and no procedure related morbidity was observed. Mean post-PVL FLRV (43.3±14.3% vs. 34.6±6.4%, p = 0.013) and VI (0.44±0.24 vs. 0.28±0.20, p = 0.029) were higher in the Alc+ group. Male sex (0.30±024 vs.0.46±0.19, p = 0.025) and portal ligation without alcohol injection (0.28±0.20 vs. 0.44±024, p = 0.029) negatively correlated with VI at univariate analysis. At multiple regression analysis both variables (male B = −0.149 p = 0.035, alcohol injection B = 0.143 p = 0.041) statistically significantly predict VI [F (1,40) = 5.200, p = 0.010]. Conclusions: Alcohol injection prior to portal vein ligation significantly increase the liver regeneration rate.