Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the future liver remnant.
The objective of this study was to assess the efficacy of right portal vein embolization (PVE) vs. right portal vein ligation (PVL) for induction of hypertrophy of the left lateral liver lobe before extended right hepatectomy. Thirty-four patients with primary or secondary liver tumors and estimated remnant functional liver parenchyma of less than 0.5% of body weight underwent either right PVE (transcutaneous, n = 10; transileocolic, n = 7) or right PVL (n = 17). Liver volume was assessed by CT scan before occlusion of the right portal vein and prior to resection. There were no deaths. The morbidity rate in each group was 5.8% (PVE, 1 abscess; PVL, 1 bile leak). The increase in liver volume was significantly higher after PVE compared with PVL (188 +/- 81 ml vs. 123 +/- 58 ml) (P = 0.012). Postoperative hospital stay was significantly shorter after PVE in comparison to PVL (4 +/- 2.9 days vs. 8.1 +/- 5.1 days; P < 0.01). Curative liver resection was performed in 10 of 17 patients after PVE and 11 of 17 patients after PVL. PVE and PVL were found to be feasible and safe methods of increasing the remnant functional liver volume and achieving resectability for extended liver tumors. PVE results in a significantly more efficient increase in liver volume and a shorter hospital stay.
Broering
Dieter C
DC
Department of Hepatobiliary Surgery, University Hospital Hamburg-Eppendorf, University of Hamburg, Martinistrasse 52, D-20246 Hamburg, Germany. broering@uke.uni-hamburg.de
Hillert
Christian
C
Krupski
Gerrit
G
Fischer
Lutz
L
Mueller
Lars
L
Achilles
Eike G
EG
Schulte am Esch
Jan
J
Rogiers
Xavier
X
D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006529:Hepatomegaly / Q000175:diagnosis*; D006801:Humans; D008026:Ligation / Q000379:methods; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008115:Liver Regeneration / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011169:Portal Vein / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome