Preoperative portal vein embolization: An audit of 84 patients

Abstract

Preoperative portal vein embolization (PVE) was performed in 84 patients before extensive liver resection for various diseases. By the criteria of liver volumetric determination, some patients were candidates for PVE, whereas others were not, even though the same surgical procedure, such as extended right lobectomy (ERL), was scheduled. PVE using gelatin sponge powder induced hypertrophy in the nonembolized lobe (0%-171%; median, 30%) and proportional atrophy in the embolized lobe in 2 weeks without eliciting any major inflammatory or necrotic reaction, as evidenced histologically and by the minimal elevations in the serum aspartate transaminase (AST) and alanine transaminase (ALT) values. Alterations in the total bilirubin level and prothrombin time were also insignificant and transient, indicating that hepatocyte functions were not impaired by PVE. Not all patients who undergo PVE proceed with the scheduled hepatic resection procedure, so it is a great advantage that gelatin sponge causes minimal damage compared with other embolizing materials such as cyanoacrylate and absolute ethanol, which have been reported to induce an inflammatory reaction or histological alteration. Our multiple regression analysis showed that three factors, diabetes mellitus, a high total bilirubin level at the time of PVE, and being male, each reduced the extent of hypertrophy in the nonembolized lobe (r 2 ‫؍‬ .30). By contrast, cholestasis appeared to accelerate the process of atrophy in the embolized lobe (r 2 ‫؍‬ .16). In conclusion, PVE by gelatin sponge powder is a safe and effective preoperative maneuver that induces hypertrophy of the section of the liver that will remain after partial hepatectomy. (HEPATOLOGY 1999;29:1099-1105

Relationship of Hepatic Functional Parameters with Changes of Functional Liver Volume Using Technetium-99m Galactosyl Serum Albumin Scintigraphy in Patients Undergoing Preoperative Portal Vein Embolization: A Follow-Up Report

“…Following PVE, previous reports have shown that the morphological volumes of the embolized and non-embolized liver change dramatically and rapidly [9,25,26], and our present study confirmed similar results [21,27]. PVE is an established strategy for major hepatectomy in patients with impaired liver function, hilar bile duct carcinoma, or hepatocellular carcinoma [3][4][5][6][7][8][9][10][11].…”

“…Better regeneration of non-embolized liver after PVE and hepatectomy may prevent post-hepatectomy complications. Predictors of changes in the embolized and non-embolized liver have been reported [9,10]; however, these have not yet been widely clarified. Our previous examination of predictors of liver volume change after PVE found that alkaline phosphatase (ALP) level was negatively correlated with atrophy of the embolized lobe, and that platelet count was positively correlated with hypertrophy of the non-embolized lobe [11].…”

The small remnant liver after major liver resection: How common and how relevant?

“…Previous studies addressing this issue have yielded conflicting results. [9][10][11]22 In the present study, the global incidence of complications (whether minor or major) and the duration of in-hospital stay were not significantly different in patients with the smallest or largest remnant liver volumes. However, a notable trend is recognized when the remnant volume decreases from 51% to 60% to Ͻ30%: the length of ICU stay doubles and hospital stay is nearly 50% longer in the small residual volume group.…”

“…The indications for PVE in patients with normal liver parenchyma vary among reports, although at hepatobiliary surgery centers, patients are typically selected by liver remnant size. Methods of measurement of the future remnant vary, 7 but most investigators propose that preoperative PVE is indicated when the measured future liver remnant volume is expected to be less than 25% to 45% of the preoperative functional liver volume (FLV) [8][9][10][11][12] or when the standardized FLV will be less than 1% of the patient's body weight (BW). 13 Recognition that these criteria have been determined empirically 7 and that the benefits of PVE may not be as obvious for patients with normal underlying liver as for patients with chronic liver disease 14,15 has led to increased interest in better definition of the indications for PVE and clearer determination of the limits of safe resection in patients with normal liver.…”

Prolonged chemotherapy impairs liver regeneration after portal vein occlusion – An audit of 26 patients

“…The negative correlation between FLR% before PVO and degree of hypertrophy, as shown in Fig. 2, has been described previously [24], but we are unaware of previous results connecting tumour size to the degree of hypertrophy (Figs. 3-4).…”