Improved liver function after portal vein embolization and an elective right hepatectomy

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Interventional radiology

Background:

• Portal vein embolization (PVE) is a standard procedure to hypertrophy the future remnant liver before extensive liver resections.
• The conventional safety margin for remnant liver volume is >0.6% of patient weight.
• The impact of PVE on post-operative liver function, independent of volume increase, requires further investigation.

Purpose of the Study:

• To evaluate if pre-operative portal vein embolization (PVE) influences post-operative liver function beyond the induced liver volume increase.
• To compare liver function markers in patients undergoing right liver resection with and without PVE.

Main Methods:

• Retrospective analysis of post-operative liver function in patients who underwent anatomical right liver resection.
• Comparison between patients who received PVE (n=28) and those who did not (n=53).
• Inclusion of living donor (LD) right liver donors (n=17) as a control group.

Main Results:

• Patients who underwent PVE showed higher post-operative factor V levels and lower bilirubin levels compared to non-PVE and LD groups.
• The PVE group experienced increased blood loss, transfusions, and sinusoidal obstruction syndrome.
• Day-3 bilirubin levels were significantly lower (40%) in the PVE group after adjusting for multiple clinical and surgical variables (P=0.001).

Conclusions:

• Pre-operative PVE appears to enhance immediate post-operative liver function in comparison to unprepared livers, even at equivalent volumes.
• Further research is warranted to determine if PVE allows for a lower threshold of remnant liver volume for safe resection.