Long-term remnant liver volume dynamics after major hepatectomy for perihilar cholangiocarcinoma following portal vein embolization

Shiori Yamazaki ¹, Akira Shimizu ¹, Koji Kubota ¹

⁰Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto City, Nagano, 390-8621, Japan.

Asian Journal of Surgery +

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April 30, 2024

View abstract on PubMed

Summary

Portal vein embolization (PVE) followed by hepatectomy shows initially lower liver remnant volume (LRV) but achieves comparable long-term liver regeneration to non-PVE cases. This suggests PVE impacts short-term, not long-term, liver recovery in perihilar cholangiocarcinoma patients.

Area Of Science

Hepatobiliary Surgery
Surgical Oncology
Liver Regeneration

Background

Portal vein embolization (PVE) followed by major hepatectomy is a standard treatment for perihilar cholangiocarcinoma (PHCC).
Long-term liver remnant volume (LRV) dynamics after PVE and hepatectomy are not well understood.
Understanding LRV changes is crucial for optimizing surgical outcomes in PHCC patients.

Purpose Of The Study

To investigate the long-term dynamics of liver remnant volume (LRV) after portal vein embolization (PVE) followed by major hepatectomy in patients with perihilar cholangiocarcinoma (PHCC).
To compare short-term and long-term liver regeneration between patients who underwent PVE and those who did not.
To identify predictors of adequate liver remnant volume at one year post-hepatectomy.

Main Methods

Retrospective analysis of 39 PHCC patients undergoing hepatectomy (2004-2021).
Comparison between PVE (n=27) and non-PVE (n=12) groups, analyzed using propensity score-matched pairs (n=10/group).
Long-term remnant liver dynamics, including LRV/future liver remnant volume (FLRV) ratios, were assessed over time.

Main Results

Short-term (1 week-1 month) LRV/FLRV was smaller in the PVE group compared to the non-PVE group (p=0.044 and p=0.003).
The PVE group demonstrated progressive hypertrophy, achieving equal LRV/FLRV to the non-PVE group by 1 year (1.96 vs. 1.97, p=0.799).
Future liver remnant volume/total liver volume (FLRV/TLV) ≤ 0.43 was the sole independent predictor for achieving LRV/FLRV ≥ 1.9 at 1 year (OR: 5.345, p=0.027).

Conclusions

While long-term LRV outcomes are similar, PVE leads to reduced short-term liver hypertrophy compared to non-PVE approaches.
Progressive hypertrophy in the PVE group compensates for initial volume deficits, normalizing LRV by one year.
FLRV/TLV ratio is a critical factor for predicting successful long-term liver remnant volume adequacy.

Keywords:

Liver volume dynamics Perihilar cholangiocarcinoma Portal vein embolization