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Background <p>Combined portal and hepatic vein embolization (cPVE-HVE) induces hypertrophy of future liver remnant before hepatectomy. We compared liver hypertrophy and post-hepatectomy outcomes between cPVE-HVE and portal vein embolization (PVE) alone.</p> Patients and Methods <p>Consecutive patient outcomes after cPVE-HVE and PVE were compared across all pathologies for degree of hypertrophy (DH), kinetic growth rate (KGR), impact of hepatic artery infusion chemotherapy (HAIC), and post-hepatectomy complications at a single center.</p> Results <p>The study cohort included 305 patients, 250 underwent PVE and 55 underwent cPVE-HVE. Pre-embolization future liver remnant (FLR) was 28% versus 32% (<i>p</i> &lt; 0.001) for cPVE-HVE and PVE. Post-embolization DH (11.3% versus 9.4%; <i>p</i> = 0.001) and KGR (3.33% versus 2.29%; <i>p</i> &lt; 0.001) were significantly greater for cPVE-HVE over shorter interval (22 versus 28 days; <i>p</i> = 0.007). HAIC was used in 42% (<i>n</i> = 23) of patients before cPVE-HVE and did not impact hypertrophy. Post-hepatectomy outcomes were similar between cPVE-HVE (<i>n</i> = 38) and PVE (<i>n</i> = 250) cohorts. Rates of transfusion (39% versus 40%; <i>p</i> &gt; 0.9), liver failure (7.9% versus 9.2%, <i>p</i> = 0.6), grade 3–5 complications (42% versus 42%, <i>p</i> &gt; 0.9), 90 day all-cause mortality (5.3% versus 3.6%, <i>p</i> = 0.6), and median hospitalization (7 versus 8 days; <i>p</i> = 0.067) were not significantly different.</p> Conclusions <p>cPVE-HVE was associated with greater hypertrophy than PVE alone, with similar post-hepatectomy outcomes. cPVE-HVE after HAIC was safe with similar hypertrophy. Randomized clinical trial evidence is needed to clearly delineate indication for cPVE-HVE and assess postoperative outcomes.</p>

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Combined Portal and Hepatic Vein Embolization Produces Greater Hypertrophy than Portal Vein Embolization Alone with Similar Post-Hepatectomy Outcomes and is not Impacted by Hepatic Artery Infusion Chemotherapy

  • 期刊论文

  • 发表日期：

    2025年4月30日

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  • Ankur P. Choubey,
  • Joanne F. Chou,
  • Kevin C. Soares,
  • Alice C. Wei,
  • Michael I. D’Angelica,
  • William R. Jarnagin,
  • Mithat Gonen,
  • Vinod P. Balachandran,
  • Jeffrey Drebin,
  • Ernesto Santos,
  • Juan C. Camacho,
  • T. Peter Kingham,
  • Fourat Ridouani

摘要

Background

Combined portal and hepatic vein embolization (cPVE-HVE) induces hypertrophy of future liver remnant before hepatectomy. We compared liver hypertrophy and post-hepatectomy outcomes between cPVE-HVE and portal vein embolization (PVE) alone.

Patients and Methods

Consecutive patient outcomes after cPVE-HVE and PVE were compared across all pathologies for degree of hypertrophy (DH), kinetic growth rate (KGR), impact of hepatic artery infusion chemotherapy (HAIC), and post-hepatectomy complications at a single center.

Results

The study cohort included 305 patients, 250 underwent PVE and 55 underwent cPVE-HVE. Pre-embolization future liver remnant (FLR) was 28% versus 32% (p < 0.001) for cPVE-HVE and PVE. Post-embolization DH (11.3% versus 9.4%; p = 0.001) and KGR (3.33% versus 2.29%; p < 0.001) were significantly greater for cPVE-HVE over shorter interval (22 versus 28 days; p = 0.007). HAIC was used in 42% (n = 23) of patients before cPVE-HVE and did not impact hypertrophy. Post-hepatectomy outcomes were similar between cPVE-HVE (n = 38) and PVE (n = 250) cohorts. Rates of transfusion (39% versus 40%; p > 0.9), liver failure (7.9% versus 9.2%, p = 0.6), grade 3–5 complications (42% versus 42%, p > 0.9), 90 day all-cause mortality (5.3% versus 3.6%, p = 0.6), and median hospitalization (7 versus 8 days; p = 0.067) were not significantly different.

Conclusions

cPVE-HVE was associated with greater hypertrophy than PVE alone, with similar post-hepatectomy outcomes. cPVE-HVE after HAIC was safe with similar hypertrophy. Randomized clinical trial evidence is needed to clearly delineate indication for cPVE-HVE and assess postoperative outcomes.