Evaluation of liver function for the application of preoperative portal vein embolization on major hepatic resection.
OBJECTIVE
Although preoperative portal vein embolization has been employed for hepatectomy to increase the safety of the surgery, patient selection criteria for hepatectomy following portal vein embolization have still not been established. In this study liver functional tests before and after portal vein embolization were evaluated in order to determine their influence on the outcome of subsequent hepatectomy and the prognostic potential of this approach.


METHODS
Forty-five patients, who had undergone major hepatic resection after embolizing the right portal branch, were divided into the following 3 groups according to their postoperative course: complication(-), complication(+), and liver failure group. Clinical, analytical, and hemodynamic parameters obtained before and after portal vein embolization were compared between the three groups.


RESULTS
Significant differences were found between the complication(-) group and the liver failure group for 8 factors, and statistically significant cut-off points distinguishing the liver failure group could be determined. Based upon values measured before PVE these were: 1) portal pressure > 16 cmH2O; 2) pre-PVE serum cholinesterase < 160 U/L; 3) pre-PVE serum hyaluronate > 130 ng/mL. Based on values measured after PVE they were: 1) a hypertrophic ratio of the left lobe < 1.21; 2) post-PVE ICGR15 (%) > 16%; 3) a portal pressure measured immediately after PVE > 25 cmH2O; 4) post-PVE serum cholinesterase < 160 U/L; 5) post-PVE serum hyaluronate > 160 ng/mL. Discriminant function analysis in a stepwise manner showed that the portal pressure and serum levels of hyaluronate measured before and after portal vein embolization were the most useful in prediction of the outcome of the following hepatectomy.


CONCLUSIONS
Patients whose data match the above criteria before portal vein embolization should be excluded as candidates for major hepatic resection with portal vein embolization. Even after portal vein embolization in patients whose data match post-portal vein embolization criteria major hepatic resection may have to be abandoned, or the extent of the hepatic resection reconsidered.
Wakabayashi
Hisao
H
First Department of Surgery, Kagawa Medical University, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. hisao-w@mxi.netwave.or.jp
Yachida
Shinichi
S
Maeba
Takashi
T
Maeta
Hajime
H
D000328:Adult; D000368:Aged; D001661:Biliary Tract Neoplasms / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D017093:Liver Failure / Q000209:etiology*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017082:Portal Pressure / Q000502:physiology; D011169:Portal Vein; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D011379:Prognosis; D012307:Risk Factors
D006820:Hyaluronic Acid