To assess the safety and efficacy of liver venous deprivation (simultaneous hepatic vein embolization with portal vein embolization) compared with portal vein embolization alone before major hepatectomy in patients with small future liver remnant.
We assessed all consecutive patients who underwent ipsilateral liver venous deprivation before major hepatectomy (>4 Couinaud’s segments) at the University Hospital Lausanne from 2016 to 2018. Postembolization, volumetric analysis after liver venous deprivation and postoperative outcomes were compared with patients who underwent portal vein embolization alone (portal vein embolization group) from 2010 to 2016.
During the study period, 21 patients underwent liver venous deprivation and 39 portal vein embolization alone. In the liver venous deprivation versus portal vein embolization groups, dropout rate owing to disease progression was 1 of 21 vs 9 of 39 (P = .053). There were no per procedural complications after liver venous deprivation and no difference in the postoperative outcomes. Future liver remnant hypertrophy was greater in the liver venous deprivation group (median 135%, interquartile range: 123%–154%) than in the portal vein embolization group (median 124%, interquartile range: 107%–140%) at a median time of 22 days after liver venous deprivation vs 26 days after portal vein embolization (P = .034). The median kinetic growth rate was also greater (2.9%/week, interquartile range: 1.9–4.3% vs 1.4%/week, interquartile range: 0.7–2.1%; P < .001).
Ipsilateral liver venous deprivation before major hepatectomy is safe and seems to induce a greater and faster future liver remnant hypertrophy than after portal vein embolization alone. More data are needed to analyze the impact of liver venous deprivation on tumor growth.
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Published online: January 31, 2020
Accepted: December 6, 2019
Reprint requests to: Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
© 2019 Published by Elsevier Inc.
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- Regarding: “Liver venous deprivation compared with portal vein embolization to induce hypertrophy of the future liver remnant before major hepatectomy: A single center experience”SurgeryVol. 168Issue 5
- PreviewDear authors, we read with great interest your recently published work1 from Kobayashi and collaborators. Nevertheless, we were surprised by the low liver regenerative results reported for portal vein embolization (PVE) with n-butyl-cyanoacrylate (NBCA) and for liver venous deprivation (LVD). Results reported for PVE were 5.6% for the degree of hypertrophy (DH) and 1.4% per week for the kinetic growth rate (KGR). Most of the previous publications have reported greater hypertrophy for PVE with NBCA, with DH ranging from 9% to 13%, and KGR ranging from 2% to 4.4% per week.
- Commentary: Liver venous deprivation: Optimizing liver regeneration with combined inflow and outflow venous occlusion of the liverSurgeryVol. 167Issue 6
- PreviewIn this issue, Kobayashi et al from Lausanne, Switzerland assessed the safety and efficacy of liver venous deprivation (LVD) (combined hepatic vein embolization [HVE] and portal vein embolization [PVE]) compared with PVE alone before major hepatectomy in patients with a small future liver remnant (FLR).1 In this study, the authors used as indication for liver venous deprivation a FLR of <35% of the total liver volume in patients with impaired function or after multiple cycles of chemotherapy and a FLR of <30% in patients with normal liver.