Improved liver function after portal vein embolization and an elective right hepatectomy.
BACKGROUND
Portal vein embolization (PVE) is used before extensive hepatic resections to increase the volume of the future remnant liver within acceptable safety margins (conventionally >0.6% of the patient's weight). The objective was to determine whether pre-operative PVE impacts on post-operative liver function independently from the increase in liver volume.


METHODS
The post-operative liver function of patients who underwent an anatomical right liver resection with (n = 28) and without (n = 53) PVE were retrospectively analysed. Donors of the right liver were also analysed (LD) (n = 17).


RESULTS
Patient characteristics were similar, except for age, weight and American Society of Anesthesiologists (ASA) score that were lower in LD. Post-operative factor V and bilirubin levels were, respectively, higher and lower in patients with PVE compared with patients without PVE or LD (P < 0.05). Patients with PVE had an increased blood loss, blood transfusions and sinusoidal obstruction syndrome. The day-3 bilirubin level was 40% lower in the PVE group compared with the no-PVE group after adjustment for body weight, chemotherapy, operating time, Pringle time, blood transfusions, remnant liver volume, pre-operative bilirubin level and pre-operative prothrombin ratio (P = 0.001).


CONCLUSIONS
For equivalent volumes, the immediate post-operative hepatic function appears to be better in livers prepared with PVE than in unprepared livers. Future studies should analyse whether the conventional inferior volume limit that allows a safe liver resection may be lowered when a PVE is performed.
Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Raphael P H
RP
Meier
Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Christian
C
Toso
Department of Radiology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Sylvain
S
Terraz
Department of Radiology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Romain
R
Breguet
Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Thierry
T
Berney
Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Axel
A
Andres
Division of Clinical Epidemiology and Clinical Research Centre, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Anne-Sophie
AS
Jannot
Division of Clinical Pathology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Laura
L
Rubbia-Brandt
Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Philippe
P
Morel
Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, Department of Surgery, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Pietro E
PE
Majno
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy*; D008297:Male; D011169:Portal Vein; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents