title: Factors influencing hypertrophy of the left lateral liver lobe after portal vein embolization.
abstract: OBJECTIVE
  Portal vein embolization (PVE) before extended right hepatectomy leads to an increase of the future liver remnant (FLR) volume, but predictive factors for sufficient hypertrophy are still unclear. The purpose of this study was to investigate parameters influencing the growth of FLR.
  
  
  METHODS
  Patients undergoing PVE prior hepatic resection were evaluated. PVE was done using polyvinyl alcohol particles only. Volumetric analysis was performed before embolization and before hepatectomy. Success of PVE was determined as percental growth of the future liver remnant.
  
  
  RESULTS
  Seventy-seven patients were included, and three cohorts were formed according to the hypertrophy of FLR. FLR increased from 448.2 ± 187 to 475.5 ± 191 in the poor, from 315.3 ± 86 to 469.1 ± 142 in the moderate, and from 283.4 ± 68 to 400.4 ± 110 in the good hypertrophy group. More cases of recanalization of the portal vein were observed in patients with poor hypertrophy (p = 0.016). Small FLR before PVE predict higher growth of the FLR (p = 0.006). Duration between PVE and surgery differed significantly: 22 (poor) vs. 32 (good) days (p = 0.040).
  
  
  CONCLUSIONS
  No recanalization, small initial FLR and longer time were assessed with better FLR hypertrophy. More sufficient PVE techniques and postponed hepatectomy might improve the outcome. Small initial FLR should not be a disclosure for curative hepatectomy.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany, maciej.malinowski@charite.de.
authors.forename: Maciej
authors.initials: M
authors.lastname: Malinowski
authors.forename: Victoria
authors.initials: V
authors.lastname: Stary
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lock
authors.forename: Antje
authors.initials: A
authors.lastname: Schulz
authors.forename: Maximilian
authors.initials: M
authors.lastname: Jara
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gebauer
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
authors.forename: Dominik
authors.initials: D
authors.lastname: Geisel
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Martin
authors.initials: M
authors.lastname: Stockmann
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003131:Combined Modality Therapy; D016208:Databases, Factual; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006984:Hypertrophy / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018365:Neoplasm, Residual / Q000473:pathology*; D009929:Organ Size; D011169:Portal Vein; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult