title: Preoperative Portal Vein Embolization before Major Hepatectomy in Patients with Excess Bilirubin does not Affect Hypertrophy of Remnant Liver and Postoperative Outcomes.
abstract: OBJECTIVE
  Preoperative portal vein embolization (PVE) has commonly used in patients who were planned major hepatectomy for avoiding the postoperative liver failure. However, the influence of serum bilirubin concentration at the time of PVE on liver regeneration and subsequent surgical outcomes have not been clarified.
  
  
  METHODS
  We retrospectively analyzed 36 patients who scheduled major hepatectomy for hepatobiliary malignancies after PVE. All patients had obstructive jaundice and underwent biliary drainage before PVE. Factors related to hypertrophy ratio of remnant liver volume (RLV) following PVE and postoperative morbidity and mortality were analysed.
  
  
  RESULTS
  Hypertrophy ratio of RLV at 2 weeks after PVE correlated positively with emboli zed liver volume/entire liver volume (ELV) ratio and mean computed tomography attenuation of the liver. RLV/ELV ratio <40% represented the only significant risk factor for postoperative hyperbilirubinemia and mortality after major hepatectomy. Serum bilirubin concentration at the time of PVE did not affect hypertrophy ratio of RLV and postoperative outcomes after major hepatectomy.
  
  
  CONCLUSIONS
  PVE in patients with elevated bilirubin levels dose not affect in hypertrophy of remnant liver and postoperative outcomes of subsequent major hepatectomy. Therefore, PVE can perform safely and effectively in patients with obstructive jaundice regardless of serum bilirubin concentration.
authors.forename: Mai
authors.initials: M
authors.lastname: Sakakibara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kato
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Katsunori
authors.initials: K
authors.lastname: Furukawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D000368:Aged; D001663:Bilirubin; D015415:Biomarkers / Q000097:blood; D049109:Cell Proliferation; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006984:Hypertrophy; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D009929:Organ Size; D011169:Portal Vein / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D001663:Bilirubin