Author/Authors :
guiu, boris st-eloi university hospital - department of radiology, Montpellier, France , quenet, françois institut du cancer de montpellier (icm) - department of surgery, Montpellier, France , panaro, fabrizio st-eloi university hospital - department of surgery, Montpellier, France , piron, lauranne st-eloi university hospital - department of radiology, Montpellier, France , cassinotto, christophe st-eloi university hospital - department of radiology, Montpellier, France , herrerro, astrid st-eloi university hospital - department of surgery, Montpellier, France , souche, françois-régis st-eloi university hospital - department of surgery, Montpellier, France , hermida, margaux st-eloi university hospital - department of radiology, Montpellier, France , pierredon-foulongne, marie-ange st-eloi university hospital - department of radiology, Montpellier, France , belgour, ali st-eloi university hospital - department of radiology, Montpellier, France , aho-glele, serge dijon university hospital - department of epidemiology, Dijon, France , deshayes, emmanuel institut de recherche en cancérologie de montpellier (ircm) - department of nuclear medicine, Montpellier, France
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% vs. +50%, P=0.002; and +18.6% vs. +52.6%, P=0.001), and in FLR-F at day 7, 14 and 21 (+23.1% vs. +54.3%, P=0.02; +17.6% vs. +56.1%, P=0.006; and +29.8% vs. +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.
Keywords :
Portal vein embolization (PVE) , liver venous deprivation (LVD) , resection , hepatectomy , mebrofenin
