Liver Venous Deprivation Versus Portal Vein Embolization Before Major Hepatectomy: Future Liver Remnant Volumetric and Functional Changes

Overview

Journal Hepatobiliary Surg Nutr

Publisher AME Publishing Company

Date 2020 Nov 9

PMID 33163507

Citations 37

Authors

Boris Guiu

Francois Quenet

Fabrizio Panaro

Lauranne Piron

Christophe Cassinotto

Astrid Herrerro

Francois-Regis Souche

Margaux Hermida

Marie-Ange Pierredon-Foulongne

Ali Belgour

Serge Aho-Glele

Emmanuel Deshayes

Affiliations

Soon will be listed here.

Abstract

Background: We previously showed that embolization of portal inflow and hepatic vein (HV) outflow (liver venous deprivation, LVD) promotes future liver remnant (FLR) volume (FLR-V) and function (FLR-F) gain. Here, we compared FLR-V and FLR-F changes after portal vein embolization (PVE) and LVD.

Methods: This study included all patients referred for liver preparation before major hepatectomy over 26 months. Exclusion criteria were: unavailable baseline/follow-up imaging, cirrhosis, Klatskin tumor, two-stage hepatectomy. 99mTc-mebrofenin SPECT-CT was performed at baseline and at day 7, 14 and 21 after PVE or LVD. FLR-V and FLR-F variations were compared using multivariate generalized linear mixed models (joint modelling) with/without missing data imputation.

Results: Baseline FLR-F was lower in the LVD (n=29) than PVE group (n=22) (P<0.001). Technical success was 100% in both groups without any major complication. Changes in FLR-V at day 14 and 21 (+14.2% +50%, P=0.002; and +18.6% +52.6%, P=0.001), and in FLR-F at day 7, 14 and 21 (+23.1% +54.3%, P=0.02; +17.6% . +56.1%, P=0.006; and +29.8% +63.9%, P<0.001) differed between PVE and LVD group. LVD (P=0.009), age (P=0.027) and baseline FLR-V (P=0.001) independently predicted FLR-V variations, whereas only LVD (P=0.01) predicted FLR-F changes. After missing data handling, LVD remained an independent predictor of FLR-V and FLR-F variations.

Conclusions: LVD is safe and provides greater FLR-V and FLR-F increase than PVE. These results are now evaluated in the HYPERLIV-01 multicenter randomized trial.

Citing Articles

SURGICAL TECHNIQUES TO INCREASE RESECTABILITY IN LIVER METASTASIS.

Torres O, Torzilli G, Enne M, Goncalves R, De Santibanes E, Pawlik T Arq Bras Cir Dig. 2025; 37():e1859.

PMID: 39841764 PMC: 11745480. DOI: 10.1590/0102-6720202400065e1859.

Liver venous deprivation (LVD) before extended hepatectomy: a French multicentric retrospective cohort.

Boubaddi M, Marichez A, Pecquenard F, Maulat C, Buc E, Sulpice L Hepatobiliary Surg Nutr. 2024; 13(6):937-949.

PMID: 39669088 PMC: 11634414. DOI: 10.21037/hbsn-24-315.

Initial experience with Double-vein Embolization in Hungary.

Korda D, Bibok A, Doros A, Horvathy D, Hahn O, Kokas B Eur J Radiol Open. 2024; 13:100613.

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Propensity Score-Matched Analysis of Liver Venous Deprivation and Portal Vein Embolization Before Planned Hepatectomy in Patients with Extensive Colorectal Liver Metastases and High-Risk Factors for Inadequate Regeneration.

Haddad A, Khavandi M, Lendoire M, Acidi B, Chiang Y, Gupta S Ann Surg Oncol. 2024; 32(3):1752-1761.

PMID: 39633174 DOI: 10.1245/s10434-024-16558-1.

Comprehensive Review of Future Liver Remnant (FLR) Assessment and Hypertrophy Techniques Before Major Hepatectomy: How to Assess and Manage the FLR.

Boubaddi M, Marichez A, Adam J, Lapuyade B, Debordeaux F, Tlili G Ann Surg Oncol. 2024; 31(13):9205-9220.

PMID: 39230854 DOI: 10.1245/s10434-024-16108-9.

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