Impact of Recanalization on Liver Hypertrophy after Portal Vein Embolization and the Role of Re-Embolization

Portal vein recanalization following portal vein embolization (PVE) can impair future liver remnant (FLR) growth; however, the clinical significance of recanalization and the utility of re-embolization remain unclear. This study aimed to assess the incidence of recanalization after PVE, its impact on liver regeneration, and the efficacy of re-embolization.

We retrospectively analyzed 249 consecutive patients who underwent hepatectomy following right PVE between 2010 and 2022. Recanalization was classified as major (section or segment) or minor (less than one segment). In this study, FLR was defined as the left hemiliver for standardization across different surgical procedures. Liver hypertrophy was assessed using the degree of hypertrophy (DH) and the kinetic growth rate (KGR). Re-embolization was performed in selected patients with insufficient FLR growth due to recanalization.

Recanalization occurred in 89 patients (36%), including 55 minor and 34 major recanalizations. DH and KGR differed significantly among the three groups. Subsequent post hoc analysis revealed that major recanalization had significantly lower DH (p = 0.002) and KGR (p = 0.003) than non-recanalization. Seven patients underwent re-embolization, which significantly improved the FLR ratio (34.2% to 39.8%, p = 0.003) without complications.

Major recanalization after PVE was significantly associated with impaired liver regeneration. Re-embolization is a potentially effective strategy for managing insufficient FLR growth due to recanalization, particularly in cases of major recanalization.