Volume Regeneration of Segments 2 and 3 After Right Portal Vein Embolization in Patients Undergoing Two-Stage Hepatectomy

Abstract

BackgroundThe impact of first-stage resection on volume regeneration of segments 2 and 3 (2 + 3) after right portal vein embolization (RPVE) in patients undergoing two-stage right hepatectomy has not been investigated. MethodVolume data for segments 2 + 3 were compared between 44 patients undergoing two-stage hepatectomy and 116 undergoing single-stage hepatectomy after RPVE. ResultsThe degree of hypertrophy (difference between standardized volume of segments 2 + 3 before and after RPVE) and kinetic growth rate (degree of hypertrophy at initial volume assessment divided by the number of weeks elapsed after RPVE) were significantly lower in patients undergoing two-stage hepatectomy (median 8.6 vs 10.5 % [p = 0.01] and 1.7 vs 2.4 % [p < 0.01], respectively). Resection volume during first-stage resection was negatively correlated with standardized volume increase from the volume before first-stage resection (R2 0.546, p < 0.01). In patients undergoing two-stage hepatectomy after RPVE with segment 4 embolization, the degree of hypertrophy and kinetic growth rate were similar to those in patients undergoing single-stage hepatectomy (p = 0.17 and p = 0.08, respectively). ConclusionIn patients undergoing two-stage hepatectomy, first-stage resection impairs the dynamics of volume regeneration of segments 2 + 3 after RPVE. When two-stage extended right hepatectomy is planned, additional embolization of segment 4 provides volume hypertrophy similar to that in patients undergoing single-stage hepatectomy.