Increase in future remnant liver function after preoperative portal vein embolization

Area of Science:

• Hepatobiliary surgery
• Interventional radiology
• Nuclear medicine

Background:

• Preoperative portal vein embolization (PVE) is crucial for patients with insufficient future remnant liver (FRL) volume to enable safe liver resection.
• While increased FRL volume post-PVE is documented, the impact on FRL function remains less understood.
• This study investigates FRL function changes after PVE using advanced imaging techniques.

Purpose of the Study:

• To evaluate the increase in FRL function after PVE.
• To compare the functional increase with the volumetric increase in FRL.
• To assess the implications for determining safe liver resection timing.

Main Methods:

• Utilized computed tomography (CT) volumetry and (99m)Tc-labelled mebrofenin hepatobiliary scintigraphy (HBS) with single photon emission computed tomography (SPECT).
• Measurements of FRL volume and FRL function were taken before and 3-4 weeks after PVE in 24 patients.
• A hypothetical model defined safe resection limits for both FRL function and volume.

Main Results:

• FRL function demonstrated a significantly greater increase compared to FRL volume post-PVE.
• A weak correlation was observed between the increase in FRL volume and FRL function.
• More patients met functional criteria for safe resection than volumetric criteria, indicating improved liver capacity.

Conclusions:

• The functional enhancement of FRL after PVE surpasses the volumetric expansion.
• These findings suggest that current waiting times for liver resection, based solely on volume, may be conservative.
• FRL function assessment via HBS/SPECT could refine surgical planning and potentially shorten the interval to resection.