Portal vein embolization to reduce postoperative liver failure rate after major liver resection

Abstract

Background: Pre- operative portal vein embolization (PVE) has been proven as an efficient procedure promot-ing liver hypertrophy to increase future liver remnant (FLR) volume. To assess the clinical efficacy of PVEs prior major hepatic resections to reduce the risk of post- operative liver failureMethods: Single- center retrospective analysis of PVEs performed between June 2005 and February 2019Results: Fifty- eight patients (M:34/F:24) with a mean age of 61 years (range 36- 79) were analysed. The average weight of the patients was 71 kg (range:54- 101). Indications for hepatic resection were cholangiocarcinoma (n=31), liver metastases (n=17), hepatocellular carcinoma (n=5), gallbladder carcinoma (n=3) and other (n=2). Right PVEs were performed in all patients except one who underwent left PVE followed by a left trisectionectomy. Resection could not be performed in one patient due to develop-ment of portal vein thrombosis following PVE. Excluding this patient, the median FLR volume prior to PVE was 470 (160- 852) cm3. After PVE, the median FLR volume progressed to 695 (230- 1000) cm3 in a median of 30 days (16- 60). Median volume increase and average rate of liver hypertrophy was 203 (16- 460) cm3 and 41% (3- 94%) con-secutively. One patient (2%) died due to an unknown cause of infection during waiting period following PVE. 86 |3ABST3RSBSurgery could not be performed in 20 patients (multiple intra- hepatic metastases: 10, carcinomatous peritonei: 5, insufficient FLR:2, hepatic arterial invasion: 2, refused surgery:1). Major liver resections were undertaken in 37 (64%) patients (right hepatectomy: 22, extended right he-patectomy/trisectionectomy: 13, left trisectionectomy:1, right hepatopancreatoduodenectomy: 1). Two patients (5%) died in the early post- operative period (within first 30 days); one due to portal vein thrombosis and the other from intraabdominal sepsis. Grade B liver failure devel-oped in 6 (17%) patients which resolved with intensive supportive treatment. Four patients had transient post- operative bile leakage; 3 from the hepaticojejunostomy anastomosis and one from the transection surface.Conclusions: PVE improves the safety of major liver re-section by lowering the risk of severe post- operative liver failureKeywords: Hepatectomy, Future liver remnant (FLR), Portal vein embolization (PVE), Liver hypertrophy, Liver failure