Factors influencing hypertrophy of the left lateral liver lobe after portal vein embolization

• Published in: Langenbeck's archives of surgery Vol. 400; no. 2; pp. 237 - 246
• Main Authors: Malinowski, Maciej, Stary, Victoria, Lock, Johan F., Schulz, Antje, Jara, Maximilian, Seehofer, Daniel, Gebauer, Bernhard, Denecke, Timm, Geisel, Dominik, Neuhaus, Peter, Stockmann, Martin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2015
• Subjects: Abdominal Surgery; Adult; Aged; Analysis of Variance; Cardiac Surgery; Combined Modality Therapy; Databases, Factual; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; Follow-Up Studies; General Surgery; Hepatectomy - methods; Humans; Hypertrophy - pathology; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neoplasm, Residual - pathology; Organ Size; Original Article; Portal Vein; Preoperative Care - methods; Radiography; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Survival Rate; Thoracic Surgery; Traumatic Surgery; Treatment Outcome; Vascular Surgery; Young Adult; Extended hepatectomy; Future liver remnant; Portal vein embolization
• DOI: 10.1007/s00423-014-1266-7
• EISSN: 1435-2451
• ISSN: 1435-2443

Purpose
Portal vein embolization (PVE) before extended right hepatectomy leads to an increase of the future liver remnant (FLR) volume, but predictive factors for sufficient hypertrophy are still unclear. The purpose of this study was to investigate parameters influencing the growth of FLR.
Methods
Patients undergoing PVE prior hepatic resection were evaluated. PVE was done using polyvinyl alcohol particles only. Volumetric analysis was performed before embolization and before hepatectomy. Success of PVE was determined as percental growth of the future liver remnant.
Results
Seventy-seven patients were included, and three cohorts were formed according to the hypertrophy of FLR. FLR increased from 448.2 ± 187 to 475.5 ± 191 in the poor, from 315.3 ± 86 to 469.1 ± 142 in the moderate, and from 283.4 ± 68 to 400.4 ± 110 in the good hypertrophy group. More cases of recanalization of the portal vein were observed in patients with poor hypertrophy (
p
 = 0.016). Small FLR before PVE predict higher growth of the FLR (
p
 = 0.006). Duration between PVE and surgery differed significantly: 22 (poor) vs. 32 (good) days (
p
 = 0.040).
Discussion
No recanalization, small initial FLR and longer time were assessed with better FLR hypertrophy. More sufficient PVE techniques and postponed hepatectomy might improve the outcome. Small initial FLR should not be a disclosure for curative hepatectomy.