Prediction of the Remnant Liver Hypertrophy Ratio after Preoperative Portal Vein Embolization

Abstract

Background: Portal vein embolization (PVE) is considered to improve the safety of major hepatectomy. Various conditions might affect remnant liver hypertrophy after PVE. The aim of the present study was to clarify the factors that affect remnant liver hypertrophy and to establish a prediction formula for the hypertrophy ratio. Methods: Fifty-nine patients who underwent preoperative PVE for cholangiocarcinoma (39 patients), metastatic carcinoma (10 patients), hepatocellular carcinoma (8 patients), and other diseases (2 patients) were enrolled in this study. For the prediction of the hypertrophy ratio, a formula with stepwise multiple regression analysis was set up. The following parameters were used: age, gender, future liver remnant ratio to total liver (FLR%), plasma disappearance rate of indocyanine green (ICGK), platelet count, prothrombin activity, serum albumin, serum total bilirubin at the time of PVE and the maximum value before PVE (Max Bil), as well as a history of cholangitis, diabetes mellitus, and chemotherapy. Results: The mean hypertrophy ratio was 28.8%. The 5 parameters detected as predictive factors were age (p = 0.015), FLR% (p < 0.001), ICGK (p = 0.112), Max Bil (p < 0.001), and history of chemotherapy (p = 0.007). The following prediction formula was established: 101.6 - 0.78 × age - 0.88 × FLR% + 128 × ICGK - 1.48 × Max Bil (mg/dl) - 21.2 × chemotherapy. The value obtained using this formula significantly correlated with the actual value (r = 0.72, p < 0.001). A 10-fold cross validation also showed significant correlation (r = 0.62, p < 0.001), and a hypertrophy ratio <20% was predictable with a sensitivity of 100% and a specificity of 90.9%. Moreover, technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin scintigraphy showed a significantly smaller increase in the uptake ratio of the remnant liver in patients with prediction values <20% than in those with values ≥20% (6.8 vs. 20.8%, p = 0.030). Conclusions: The prediction formula can prognosticate the hypertrophy ratio after PVE, which may provide a new therapeutic strategy for major hepatectomy.

Correlation Between Sarcopenia and Growth Rate of the Future Liver Remnant After Portal Vein Embolization in Patients with Colorectal Liver Metastases

“…Depending on various factors, such as the degree of liver cirrhosis and pretreatment with hepatotoxic chemotherapy, the volume of the FLR should be at least 20-40% of the total liver volume in order to be eligible for surgery (TLV) [3][4][5]. The degree of hypertrophy (DH) of the FLR after PVE also varies greatly between patients, and several studies have developed approaches to predict FLR growth based on laboratory values and clinicopathologic data, such as bilirubin levels and history of previous chemotherapy or liver surgery [6,7]. Recently, sarcopenia, the degenerative loss of skeletal muscle mass and function [8], has been shown to correlate with morbidity and mortality after major liver surgery and has been shown to adversely affect the outcome in various other severe diseases as well [9][10][11][12].…”

Chronological Profiling of Plasma Native Peptides after Hepatectomy in Pigs: Toward the Discovery of Human Biomarkers for Liver Regeneration

“…Furthermore, it would be interesting to compare these observations with those in other models such as carbon tetrachloride-induced liver injury model as we have done using mice [38]. The approach adopted in this study is considered to be applicable to the search for biomarkers of liver regeneration not only after PHx but also after preoperative portal vein embolization [41], and after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) surgery [42], and therefore, we cautiously plan to conduct clinical trials and elucidate biomarkers for clinical use in our subsequent work.…”

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

“…Several authors have reported factors predictive of liver regeneration following PVE, such as pre-PVE FLR volume,[20, 29] receipt of chemotherapy,[33] and functional hepatic reserve. [33, 34] However, their analyses were based on the hypertrophy rate of the FLR (increase of FLR/pre-PVE FLR).…”

“…Several authors have reported factors predictive of liver regeneration following PVE, such as pre-PVE FLR volume,[20, 29] receipt of chemotherapy,[33] and functional hepatic reserve. [33, 34] However, their analyses were based on the hypertrophy rate of the FLR (increase of FLR/pre-PVE FLR). In contrast, we investigated predictors including administration of 2-stage hepatectomy based on DH (increase of standardized volume of S2+3) and KGR (DH at first assessment/time elapsed since PVE) because these kinetic profiles are able not only to evaluate the trophic effects of PVE but also to predict postoperative morbidity and mortality after major hepatectomy.…”