Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure.

Published

Journal Article

BACKGROUND: After portal vein embolization (PVE), the future liver remnant (FLR) hypertrophies for several weeks. An early marker that predicts a low risk of post-hepatectomy liver failure can 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 were measured. Degree of hypertrophy (DH = post-FLR/post-functional liver volume - pre-FLR/pre-functional liver volume) and growth rate (GR = DH/weeks since PVE) were calculated. Postoperative complications and liver failure were correlated with DH, measured GR, and estimated GR 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%). Nonparametric regression showed that post-embolization FLR percent correlated poorly with liver failure. Receiver operating characteristic curves showed that DH and GR were good predictors of liver failure (area under the curve [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% per week had liver failure develop. The predictive value of measured GR was superior to estimated GR 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. Growth rate might be a better guide for the optimum timing of liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.

Full Text

Duke Authors

Cited Authors

  • Leung, U; Simpson, AL; Araujo, RLC; Gönen, M; McAuliffe, C; Miga, MI; Parada, EP; Allen, PJ; D'Angelica, MI; Kingham, TP; DeMatteo, RP; Fong, Y; Jarnagin, WR

Published Date

  • October 2014

Published In

Volume / Issue

  • 219 / 4

Start / End Page

  • 620 - 630

PubMed ID

  • 25158914

Pubmed Central ID

  • 25158914

Electronic International Standard Serial Number (EISSN)

  • 1879-1190

Digital Object Identifier (DOI)

  • 10.1016/j.jamcollsurg.2014.04.022

Language

  • eng

Conference Location

  • United States