Portal vein embolization before right hepatectomy: prospective clinical trial.
OBJECTIVE
To assess the impact of liver hypertrophy of the future liver remnant volume (FLR) induced by preoperative portal vein embolization (PVE) on the immediate postoperative complications after a standardized major liver resection.


BACKGROUND
PVE is usually indicated when FLR is estimated to be too small for major liver resection. However, few data exist regarding the exact quantification of sufficient minimal functional hepatic volume required to avoid postoperative complications in both patients with or without chronic liver disease.


METHODS
All consecutive patients in whom an elective right hepatectomy was feasible and who fulfilled the inclusion and exclusion criteria between 1998 and 2000 were assigned to have alternatively either immediate surgery or surgery after PVE. Among 55 patients (25 liver metastases, 2 cholangiocarcinoma, and 28 hepatocellular carcinoma), 28 underwent right hepatectomy after PVE and 27 underwent immediate surgery. Twenty-eight patients had chronic liver disease. FLR and estimated rate of functional future liver remnant (%FFLR) volumes were assessed by computed tomography.


RESULTS
The mean increase of FLR and %FFLR 4 to 8 weeks after PVE were respectively 44 +/- 19% and 16 +/- 7% for patients with normal liver and 35 +/- 28% and 9 +/- 3% for those with chronic liver disease. All patients with normal liver and 86% with chronic liver disease experienced hypertrophy after PVE. The postoperative course of patients with normal liver who underwent PVE before right hepatectomy was similar to those with immediate surgery. In contrast, PVE in patients with chronic liver disease significantly decreased the incidence of postoperative complications as well as the intensive care unit stay and total hospital stay after right hepatectomy.


CONCLUSIONS
Before elective right hepatectomy, the hypertrophy of FLR induced by PVE had no beneficial effect on the postoperative course in patients with normal liver. In contrast, in patients with chronic liver disease, the hypertrophy of the FLR induced by PVE decreased significantly the rate of postoperative complications.
Farges
Olivier
O
Department of Digestive Surgery, Hospital Beaujon, 100, Boulevard du Général Leclerc, 92118 Clichy Cedex, France.
Belghiti
Jacques
J
Kianmanesh
Reza
R
Regimbeau
Jean Marc
JM
Santoro
Roberto
R
Vilgrain
Valérie
V
Denys
Alban
A
Sauvanet
Alain
A
D000328:Adult; D000368:Aged; D001837:Body Weights and Measures / Q000295:instrumentation; D002908:Chronic Disease; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008107:Liver Diseases / Q000097:blood / Q000601:surgery* / Q000628:therapy; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies; D036542:Tomography, Spiral Computed