Surgical Strategy for Future Remnant Liver Hypertrophy: Portal Vein Embolization vs. Liver Venous Deprivation

Preoperative portal vein embolization (PVE) is the standard technique used to increase the size of the future remnant liver (FRL) before major hepatectomies. Another method to increase the FRL is liver venous deprivation (LVD), but its clinical and operative impact is still unknown. The aim of this study is to compare perioperative findings, morbidity and mortality and the increase in FRL volume (FRL-V) and FRL function (FRL-F) between PVE and LVD. Fifty-two patients undergoing PVE and LVD before a major hepatectomy were retrospectively analyzed between 2015 and 2018. Intra-operative parameters, postoperative complications and histological findings were compared. For the volumetric and functional assessment, we collected the results from CT-scan and 99m-technetium (Tc)-Mebrofenin hepatobiliary scintigraphy (HBS) realized at day 7 th, 14th and 21th after embolization procedure. To induce FRL growth 25 patients underwent PVE and 23 LVD. No differences between the two groups were found in terms of intraoperative bleeding (P=0.9), hepatic pedicle clamping (P=0.46), intraoperative red blood cells transfusions (P=0.42) and operative time (P=0.95). Post-operative course was similar when comparing complications in the two arms (P=0.8). No difference in biliary leak (P=0.27), hemorrhage (P=0.11) and liver failure (P=0.6) was found. The two groups were also similar in terms of FRL-V increase, but there was a significant difference in favor of LVD group regarding the FRL-F increase at day 14 th and 21th.LVD technique seems to be feasible, well tolerated and provides fast and important hypertrophy of the FRL, without influencing the morbidity and mortality rate during and after major hepatectomy.