Portal and hepatic vein embolization prior to major hepatectomy

Abstract

Purpose To analyze safety and effectiveness of simultaneous portal and hepatic vein embolization (PHVE) or sequential hepatic vein embolization (HVE) compared to portal vein embolization (PVE) for future remnant liver (FRL) hypertrophy prior to major hepatic surgery.

Methods Patients undergoing PVE, PHVE or HVE at our tertiary care center between 2018 and 2020 were retrospectively included. FRLV, standardized FRLV (sFRLV) and sFRLV growth rate per day were assessed via volumetry, as well as laboratory parameters.

Results 36 patients (f = 15, m = 21; median 64.5 y) were included, 16 patients received PHVE and 20 patients PVE, of which 4 received sequential HVE. Significant increase of FRLV was achieved with both PVE and PHVE compared to baseline (p < 0.0001). sFRLV growth rate did not significantly differ following PHVE (2.2 ± 1.2 %/d) or PVE (2.2 ± 1.7 %/d, p = 0.94). Left portal vein thrombosis (LPVT) was observed after PHVE in 6 patients and in 1 patient after PVE. Sequential HVE showed a considerably high growth rate of 1.42 ± 0.45 %/d after PVE.

Conclusion PHVE effectively induces FRL hypertrophy but yields comparable sFRLV to PVE. Sequential HVE further induces hypertrophy after insufficient growth due to PVE. Considering a potentially higher rate of LPVT after PHVE, PVE might be preferred in patients with moderate baseline sFRLV, with optional sequential HVE in non-sufficient responders.

Zusammenfassung

Ziel Analyse von Sicherheit und Effektivität der future remnant liver (FRL) Hypertrophieinduktion vor Leberresektion durch eine simultane Pfortader- und Lebervenenembolisation (PHVE) oder sequentiellen Lebervenenembolisation (HVE) im Vergleich zur Pfortaderembolisation (PVE).

Methodik Alle Patienten mit PVE, PHVE oder HVE zwischen 2018 und 2020 aus einem Universitätsklinikum wurden retrospektiv eingeschlossen. FRLV, standardisiertes FRLV (sFRLV) und sFRLV Wachstumsrate pro Tag sowie die Laborwerte wurden analysiert.

Ergebnisse 36 Patienten (f = 15, m = 21; Median: 64,5 Jahre) wurden eingeschlossen; 16 Patienten erhielten eine PHVE und 20 Patienten eine PVE (4 davon sequentielle HVE). Eine signifikante FRLV-Zunahme wurde mit der PVE und der PHVE erzielt (p < 0,0001). Die sFRLV Wachstumsrate zeigte keinen signifikanten Unterschied zwischen PHVE (2,2 ± 1,2 %/d) und PVE (2,2 ± 1,7 %/d, p = 0,94). 6 bzw.1 Patient zeigten eine linksseitige Thrombose nach PHVE bzw. PVE. Die sequentielle HVE zeigte eine deutliche sFRLV Wachstumsrate von 1,42 ± 0,45 %/d.

Schlussfolgerung Die PHVE führt effektiv zu einer Hypertrophie, die Wachstumsrate ist jedoch vergleichbar zur PVE. Die sequentielle HVE induziert jedoch eine zusätzliche Hypertrophie nach insuffizienter PVE. Unter Berücksichtigung einer womöglich höheren Thromboserate nach PHVE, sollte die PVE bei moderatem FRL-Ausgangsvolumen bevorzugt werden, mit der Option zu einer sequentiellen HVE bei insuffizienter PVE.

Key words

portal vein embolization - hepatic vein embolization - future remnant liver - major hepatectomy - post-operative liver failure - liver Hypertrophy

Schlüsselwörter

Portalvenenembolisation - Lebervenenembolisation - Future remnant liver - Major-Leberresektion - postoperatives Leberversagen - Leberhypertrophie

Publikationsverlauf

Eingereicht: 30. Oktober 2020

Angenommen: 04. Dezember 2020

Artikel online veröffentlicht:
11. Januar 2021

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