Remnant Growth Rate after Portal Vein Embolization Is a Good Early Predictor of Post-Hepatectomy Liver Failure

Abstract

Background After portal vein embolization (PVE), the future liver remnant (FLR) hypertrophies over several weeks. An early marker that predicts a low risk of post-hepatectomy liver failure may reduce the delay to surgery. Study Design Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional liver volume (FLV) were measured. Degree of hypertrophy (DH = postFLR/postFLV - preFLR/preFLV) and growth rate (GR = DH / weeks since PVE) were calculated. Postoperative complications and liver failure were correlated with DH, measured GR, and estimated GR (eGR) derived from a formula based on body surface area. Results Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7%) and liver failure in 6 patients (3.9%). Non-parametric regression showed that post-embolization FLR% correlated poorly with liver failure. ROC curves showed that DH and GR were good predictors of liver failure (AUC=0.80, p=0.011, and AUC=0.79, p=0.015) and modest predictors of major complications (AUC=0.66, p=0.002, and AUC=0.61, p=0.032). No patient with GR >2.66%/wk developed liver failure. The predictive value of measured GR was superior to eGR for liver failure (AUC 0.79 vs 0.58, p=0.046). Conclusions Both DH and GR after PVE are strong predictors of post-hepatectomy liver failure. GR may be a better guide for the optimum timing of liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.

Serial changes of cytokines and growth factors in peripheral circulation after right lobe donor hepatectomy

“…This is the first study to describe serial changes in plasma biomarker levels after partial hepatectomy in a uniform population. It is well known that liver regeneration is rapid in the first 2 weeks after liver resection, but it continues for many weeks after partial hepatectomy; plus, the factors involved in termination of liver regeneration are not well known. Another key point of this study is that the biomarkers were analyzed until the end of 6 weeks after hepatectomy in order to study the markers involved in the termination of liver regeneration process.…”

Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization—the effect of collaterals on embolized liver volume

“…6,28 Recent data support this hypothesis with the use of non-parametric regression and showed that post embolization, no patient with a growth rate .2.66% per week developed liver failure. 29 In patients with chronic liver disease, some investigators have adopted algorithms incorporating functional tests, such as the indocyanine green retention rate, which has been proposed as an adjunct to the volumetric measurements. 30,31 However, despite encouraging results, widespread clinical acceptance is lacking so far.…”

Central Hepatectomy for Biliary Cystadenoma: Parenchyma-Sparing Approach for Benign Lesions

“…The conventional strategy to avoid postoperative liver failure involves determination of the future remnant liver volume and, when indicated, selective portal vein embolization together with degree of hypertrophy of remnant liver 5 . In cases of anticipated insuficient hypertrophy such as patients with severe steatosis, long-term chemotherapy and cirrhosis CH can be considered.…”