Factors Affecting Left Lobe Hypertrophy after Right Portal Vein Embolization in Patients with Chronic Liver Disease

Abstract

Background: Right portal vein embolization (PVE), performed either surgically or radiologically, is the main method used to induce growth of the future liver remnant (FLR) before right hemihepatectomy in patients with an insufficient future liver remnant volume (FLRV) due to chronic liver disease. The purpose of this study was to evaluate whether clinical and laboratory variables, as well as METAVIR fibrosis score, are predictive of PVE-induced growth of the FLR in patients with chronic liver disease. Methods: During the period from January 2007 to September 2014, a total of 813 patients underwent hemihepatectomy for hepatocellular carcinoma (HCC) or cholangiocarcinoma. Of those patients, 20 had an inadequate FLR and required right PVE before hemihepatectomy. None of the 20 patients had received preoperative chemotherapy or transarterial chemoembolization. Results: Of the parameters evaluated (serum levels of AST, ALT, ALP, GGT, albumin, total bilirubin, AFP, prothrombin time, Child- Pugh score, METAVIR fibrosis score and history of hepatitis B or hepatitis C infection), only the fibrosis score was associated with a significant change in the estimated rate of functional future liver remnant (%FFLR) volume (p = 0.042). Further analysis revealed that only mild (F1) and moderate (F2) degrees of fibrosis were associated with a significant increase in the FLRV (p = 0.043 and p = 0.028, respectively). Conclusion: The severity of liver fibrosis was found to be negatively correlated with the degree of FLR hypertrophy prior to portal vein embolization.