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Factors influencing hypertrophy of the left lateral liver lobe after portal vein embolization

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Abstract

Purpose

Portal vein embolization (PVE) before extended right hepatectomy leads to an increase of the future liver remnant (FLR) volume, but predictive factors for sufficient hypertrophy are still unclear. The purpose of this study was to investigate parameters influencing the growth of FLR.

Methods

Patients undergoing PVE prior hepatic resection were evaluated. PVE was done using polyvinyl alcohol particles only. Volumetric analysis was performed before embolization and before hepatectomy. Success of PVE was determined as percental growth of the future liver remnant.

Results

Seventy-seven patients were included, and three cohorts were formed according to the hypertrophy of FLR. FLR increased from 448.2 ± 187 to 475.5 ± 191 in the poor, from 315.3 ± 86 to 469.1 ± 142 in the moderate, and from 283.4 ± 68 to 400.4 ± 110 in the good hypertrophy group. More cases of recanalization of the portal vein were observed in patients with poor hypertrophy (p = 0.016). Small FLR before PVE predict higher growth of the FLR (p = 0.006). Duration between PVE and surgery differed significantly: 22 (poor) vs. 32 (good) days (p = 0.040).

Discussion

No recanalization, small initial FLR and longer time were assessed with better FLR hypertrophy. More sufficient PVE techniques and postponed hepatectomy might improve the outcome. Small initial FLR should not be a disclosure for curative hepatectomy.

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Acknowledgments

We greatly appreciate Sina Lehmann, Lina Demirel and Rea Roehl for their help in performing the study.

Conflicts of interest

Martin Stockmann is the inventor of the LiMAx test and has capital interest in Humedics, the company marketing the LiMAx test. Maximilian Jara disclosed receiving research grants in order of the d-LIVER European Commission Framework Programme (www.d-liver.eu). Remaining authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

Authors’ contributions

MM and VS contributed to conception and design of the study, analysed and interpreted data, wrote the manuscript and finally approved the manuscript; JFL, AS, MJ, DS, TD and DG analysed and interpreted data, revised the manuscript and finally approved the manuscript; BG, PN and MS contributed to conception and design of the study, revised the manuscript and finally approved the manuscript.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Maciej Malinowski, Victoria Stary, Johan F. Lock, Antje Schulz, Maximilian Jara, Daniel Seehofer, Peter Neuhaus & Martin Stockmann

  2. Department of Radiology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany

    Bernhard Gebauer, Timm Denecke & Dominik Geisel

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  1. Maciej Malinowski
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Correspondence to Maciej Malinowski.

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Maciej Malinowski and Victoria Stary contributed equally to the manuscript.

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Malinowski, M., Stary, V., Lock, J.F. et al. Factors influencing hypertrophy of the left lateral liver lobe after portal vein embolization. Langenbecks Arch Surg 400, 237–246 (2015). https://doi.org/10.1007/s00423-014-1266-7

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  • DOI: https://doi.org/10.1007/s00423-014-1266-7

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