Abstract
Purpose
Simultaneous dual hepatic vein embolization (DHVE) has been proposed for safe right-sided hepatectomy, with good results for liver hypertrophy and function. However, the histological and radiological findings of DHVE have not been thoroughly investigated.
Methods
This study included 14 patients who underwent DHVE before right-sided major hepatectomy. DHVE was performed if the future liver remnant was < 35% or borderline, but with concomitant vascular resection. The liver function was assessed using the signal intensity on Gd–EOB–DTPA–MRI. A histological evaluation of the area of DHVE and portal vein embolization (PVE) were performed.
Results
The median pre- and post-functional liver remnants were 363 ml and 498 ml, respectively (p < 0.001). The median growth rate was 48.6%, and there was no post-hepatectomy liver failure in the patients who underwent DHVE. The signal intensity ratio in the area of DHVE was lower than that in the areas of PVE and the remnant liver (p < 0.01). The degree of congestion and necrosis was greater in the area of DHVE than in the area of PVE alone (p < 0.01 and p = 0.04, respectively).
Conclusions
We observed good liver hypertrophy after DHVE and histological and radiological changes in the area of DHVE. Our findings provide a compelling rationale for further investigation of the mechanism of liver hypertrophy in DHVE.
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Funding
This work was supported by JSPS KAKENHI grant numbers JP21K08718 (to T.I.) and JP21K08805 (to K. H.), and by research grants from the Yakult Bio-Science Foundation (to K.H.) and Takeda Science Foundation (to K.H.).
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KH and TI developed the main concepts and designed the study. KH, MT, KG, HA, KF, and SS were responsible for acquisition of clinicopathological data. TG and SS performed the histological evaluation. KH and TI performed the data analysis and interpretation. KH and TI drafted the manuscript. MT, KG, HA, KF, YS, YY, SS, and SO contributed to the editing and critical revision of important intellectual content.
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This study protocol was approved by the ethics committee of Jikei University School of Medicine (No. 32-504). Patients were given the opportunity to opt out of this study through public announcements.
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Haruki, K., Tsunematsu, M., Gomisawa, K. et al. Histological and radiological analysis of simultaneous dual hepatic vein embolization for right-sided major hepatectomy. Surg Today (2024). https://doi.org/10.1007/s00595-024-02859-1
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DOI: https://doi.org/10.1007/s00595-024-02859-1