Liver Venous Deprivation Versus Portal Vein Embolization Before Major Hepatectomy for Colorectal Liver Metastases: A Retrospective Comparison of Short- and Medium-Term Outcomes

Abstract

Background Liver venous deprivation (LVD) is a recent radiological technique performed to induce hypertrophy of the future liver remnant. Medium-term results of major hepatectomy after LVD have never been compared with the actual standard of care, portal vein embolization (PVE). Methods We retrospectively compared data from 33 consecutive patients who had undergone LVD ( n = 17) or PVE ( n = 16) prior to a right hemi-hepatectomy or right extended hepatectomy indicated for colorectal liver metastases (CRLM) between May 2015 and December 2019. Results The 1-year and 3-year overall survival (OS) rates in the LVD group were 81.3% (95% confidence interval [CI]: 72–90) and 54.7% (95% CI: 46–63), respectively, against 85% (95% CI: 69–101) and 77.4% (95% CI: 54–100) in the PVE group; the differences were not statistically significant ( p = 0.64). The median disease-free survival (DFS) rate was also comparable: 6 months (95% CI: 4–7) in the LVD group and 12 months (95% CI: 1.5–13) in the PVE group ( p = 0.29). The overall intra-operative and post-operative complication rates were similar between the two groups. The mean daily kinetic growth rate (KGR) was found to be higher after LVD than after PVE (0.2% vs. 0.1%, p = 0.05; 10 cc/day vs. 4.8 cc/day, p = 0.03), as was the mean increase in future liver remnant volume (FLR-V) (49% vs. 27%, p = 0.01). Conclusions The LVD technique is well tolerated in patients undergoing right hemi-hepatectomy or right extended hepatectomy for CRLM. When compared with the PVE technique, the LVD technique has similar peri-operative and medium-term outcomes, but higher KGR and FLR-V increase.

A systematic review and meta-analysis of liver venous deprivation versus portal vein embolization before hepatectomy: future liver volume, postoperative outcomes, and oncological safety

“…Five studies reported FLR percentage after embolization ( 21 , 23 – 26 ). This outcome was reported in 120 and 257 patients in the LVD and PVE groups, respectively.…”

“…Five studies reported the operative time ( 21 , 23 , 25 , 27 , 28 ). This outcome was reported in 110 patients in the LVD group and 201 patients in the PVE group.…”

“…Three studies reported the bile leak rates ( 21 , 26 , 28 ). It was reported in five of 62 patients in the LVD group and six in 63 patients in the PVE group.…”

Portal Vein Embolization: Rationale, Techniques, and Outcomes to Maximize Remnant Liver Hypertrophy with a Focus on Contemporary Strategies

“…In a follow-up study of 10 patients, FLR percentage volume was increased up to 53.4% as early as 7 days following LVD [ 72 ]. Recent studies have further demonstrated the efficacy of LVD, even when compared to PVE alone or to ALPPS [ 73 , 74 , 75 ].…”

Assessment of Segmentary Hypertrophy of Future Remnant Liver after Liver Venous Deprivation: A Single-Center Study

“…Some preliminary studies focused on the differences between PVE and LVD/eLVD, the degree of hypertrophy, postoperative complications, delay between embolization and surgery, but to our knowledge, none of them have compared the segmentary volumetry and the distribution of hypertrophy in the FRL [ 19 , 20 , 21 ].…”