Future remnant liver function as predictive factor for the hypertrophy response after portal vein embolization

Area of Science:

• Hepatobiliary scintigraphy
• Liver surgery
• Radiology

Background:

• Preoperative portal vein embolization (PVE) is a standard procedure to augment future remnant liver (FRL) volume.
• Identifying non-responders to PVE is crucial for considering alternative treatments like associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).
• ^99mTc-mebrofenin hepatobiliary scintigraphy offers quantitative assessment of FRL function, aiding in predicting postoperative liver failure.

Purpose of the Study:

• To evaluate the utility of pre-PVE FRL function in predicting a sufficient hypertrophic response post-PVE.
• To identify patients with insufficient FRL function after PVE who might be candidates for ALPPS.

Main Methods:

• Sixty-three patients undergoing PVE were assessed using computed tomography and ^99mTc-mebrofenin hepatobiliary scintigraphy.
• FRL function was measured before and after PVE.
• Receiver operator characteristic (ROC) analysis was employed to determine the predictive value of pre-PVE FRL function for achieving a safe post-PVE FRL function cutoff (≥2.7%/min/m²).

Main Results:

• Mean FRL function increased from 1.80%/min/m² pre-PVE to 2.89%/min/m² post-PVE.
• In non-chemotherapy patients (n=33), pre-PVE FRL function ≥1.72%/min/m² predicted sufficient FRL function post-PVE (AUC=0.820).
• The predictive accuracy was lower in patients receiving neoadjuvant chemotherapy (n=30, AUC=0.618). Four of five patients with postoperative liver failure had post-PVE FRL below the safe cutoff.

Conclusions:

• Pre-PVE FRL function, assessed by hepatobiliary scintigraphy, can predict insufficient functional hypertrophy after PVE.
• This assessment is particularly valuable in patients not undergoing chemotherapy, identifying potential candidates for ALPPS.
• Early functional assessment aids in surgical planning and patient selection for liver resection.