Purpose: In patients with inadequate future liver remnant (FLR) volume preparing for major liver resection, the current mainstay to induce hypertrophy of the FLR is portal vein embolization (PVE), which has been shown to increase the FLR by 37.9%-43.2% (van Lienden et al., 2013; Isfordink et al., 2017). However, average duration from embolization to repeat imaging is widely variable, ranging anywhere from 2-8 weeks (van Lienden et al., 2013; Isfordink et al., 2017). A recently described technique in Europe combining portal and hepatic venous embolization (PHembo) preoperatively may increase FLR volume and rate of growth beyond that of PVE alone (Le Roy et al., 2019). In two initial published reports, patients who underwent PHembo experienced FLR volume increase 46.4%-52.6%, ratio of FLR to total liver volume (TLV) rise from 21.0%-28.2% pre-embolization to 40.9%-52.6% post-embolization, and a kinetic growth rate of FLR of 18% per week (Guiu et al., 2016; Le Roy et al., 2017). This may also allow for reduced time to surgical resection. The objective of this study was to report our North American experience with this technique.
Material and Methods: A retrospective study was performed of patients who underwent PHembo before major liver resection between 2017 and 2019. Liver volumetry was assessed by CT or MR cross-sectional imaging before embolization and then re-imaged prior to surgical resection.
Results: Between March 2017 and October 2019, six patients underwent PHembo for liver hypertrophy. The mean FLR volume increase was 355cc (±86.0cc) at a median 14 days after embolization, correlating with a FLR hypertrophy of 61.4% (±51.5%). The kinetic growth rate was 34% (±29%) per week. The ratio of FLR to TLV rose from 23.5% (±5.1%) to 36.0% (±3.3%) post embolization. Subsequently, all 6 patients underwent successful liver resection a median of 16 days post-embolization with no incidents of postoperative liver failure.
Conclusions: Our experience demonstrates that PHembo quickly and substantially hypertrophies the FLR in preparation for major liver resection without additional morbidity.