title: Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure.
abstract: BACKGROUND
  After portal vein embolization (PVE), the future liver remnant (FLR) hypertrophies for several weeks. An early marker that predicts a low risk of post-hepatectomy liver failure can reduce the delay to surgery.
  
  
  METHODS
  Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional liver volume were measured. Degree of hypertrophy (DH = post-FLR/post-functional liver volume - pre-FLR/pre-functional liver volume) and growth rate (GR = DH/weeks since PVE) were calculated. Postoperative complications and liver failure were correlated with DH, measured GR, and estimated GR derived from a formula based on body surface area.
  
  
  RESULTS
  Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7%) and liver failure in 6 patients (3.9%). Nonparametric regression showed that post-embolization FLR percent correlated poorly with liver failure. Receiver operating characteristic curves showed that DH and GR were good predictors of liver failure (area under the curve [AUC] = 0.80; p = 0.011 and AUC = 0.79; p = 0.015) and modest predictors of major complications (AUC = 0.66; p = 0.002 and AUC = 0.61; p = 0.032). No patient with GR >2.66% per week had liver failure develop. The predictive value of measured GR was superior to estimated GR for liver failure (AUC = 0.79 vs 0.58; p = 0.046).
  
  
  CONCLUSIONS
  Both DH and GR after PVE are strong predictors of post-hepatectomy liver failure. Growth rate might be a better guide for the optimum timing of liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Universe
authors.initials: U
authors.lastname: Leung
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Simpson
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Raphael L C
authors.initials: RL
authors.lastname: Araujo
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gönen
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Conor
authors.initials: C
authors.lastname: McAuliffe
authors.affiliation: Department of Biomedical Engineering, Vanderbilt University, Nashville, TN.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Miga
authors.affiliation: Pathfinder Therapeutics Inc., Nashville, TN.
authors.forename: E Patricia
authors.initials: EP
authors.lastname: Parada
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: jarnagiw@mskcc.org.
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D006984:Hypertrophy; D008099:Liver / Q000473:pathology*; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008113:Liver Neoplasms / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome