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Changes in blood flow and function of the liver after right portal vein embolization
Ryo Shimada1, Hiroshi Imamura, Ataru Nakayama
1First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Hypothesis:
Abrupt occlusion of hemihepatic portal vein induced by preoperative portal vein embolization (PVE) may result in drastic alterations in blood flow and functional mass of the liver.
Design:
Prospective study investigating the outcome of an intervention (PVE).
Setting:
University tertiary-care referral center.
Patients:
Thirteen patients who underwent PVE before extended right hepatectomy.
Main Outcome Measures:
The functional plasma flow and functional mass of the liver as well as the volumes of the left and right lobes were assessed before and after PVE. The functional plasma flow and functional mass of the liver were estimated by measuring the hepatic clearances of sorbitol (a high-extraction drug) and antipyrine (a low-extraction drug), respectively. The liver lobar volumes were measured by computed tomography.
Results:
Hepatic plasma clearance of sorbitol (mean +/- SD; before PVE, 632.9 +/- 142.9 mL/min; day 14, 620.2 +/- 138.3 mL/min; not significant by 1-way repeated analysis of variance) and that of antipyrine (before PVE, 27.3 +/- 12.0 mL/min; day 14, 27.9 +/- 13.6 mL/min; P =.85, by paired t test) were stable after PVE. Fourteen days after PVE, the non-PVE-treated lobe was enlarged (mean +/- SD, 137% +/- 30%) and the PVE-treated lobe was atrophic (mean +/- SD, 87% +/- 15%); however, the total liver volume did not change significantly.
Conclusions:
The functional mass and plasma flow of the entire liver were stable after PVE despite the drastic change in the lobar distribution of the portal blood flow, whereas the non-PVE-treated lobe increased significantly in size. Our findings suggest that PVE leads to an increase in both the volume and the functional capacity of the non-PVE-treated lobe.