Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure Journal Article
| Authors: | Leung, U.; Simpson, A. L.; Araujo, R. L. C. ; Gonen, M.; McAuliffe, C.; Miga, M. I.; Parada, E. P.; Allen, P. J.; D'Angelica, M. I.; Kingham, T. P.; DeMatteo, R. P.; Fong, Y.; Jarnagin, W. R. |
| Article Title: | Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure |
| Abstract: | Background After portal vein embolization (PVE), the future liver remnant (FLR) hypertrophies for several weeks. An early marker that predicts a low risk of post-hepatectomy liver failure can reduce the delay to surgery. Study Design Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional liver volume were measured. Degree of hypertrophy (DH = post-FLR/post-functional liver volume - pre-FLR/pre-functional liver volume) and growth rate (GR = DH/weeks since PVE) were calculated. Postoperative complications and liver failure were correlated with DH, measured GR, and estimated GR derived from a formula based on body surface area. Results Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7%) and liver failure in 6 patients (3.9%). Nonparametric regression showed that post-embolization FLR percent correlated poorly with liver failure. Receiver operating characteristic curves showed that DH and GR were good predictors of liver failure (area under the curve [AUC] = 0.80; p = 0.011 and AUC = 0.79; p = 0.015) and modest predictors of major complications (AUC = 0.66; p = 0.002 and AUC = 0.61; p = 0.032). No patient with GR >2.66% per week had liver failure develop. The predictive value of measured GR was superior to estimated GR for liver failure (AUC = 0.79 vs 0.58; p = 0.046). Conclusions Both DH and GR after PVE are strong predictors of post-hepatectomy liver failure. Growth rate might be a better guide for the optimum timing of liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics. |
| Keywords: | adult; cancer chemotherapy; treatment outcome; aged; middle aged; retrospective studies; major clinical study; bevacizumab; fluorouracil; artificial embolism; liver cell carcinoma; systemic therapy; liver neoplasms; nuclear magnetic resonance imaging; follow up; methodology; follow-up studies; magnetic resonance imaging; computer assisted tomography; heart disease; abdominal abscess; tomography, x-ray computed; pathology; retrospective study; time; time factors; irinotecan; postoperative complication; postoperative complications; liver failure; liver; colorectal tumor; liver tumor; intraarterial drug administration; liver resection; hepatectomy; bile duct carcinoma; oxaliplatin; liver parenchyma; wound infection; portal vein; embolization, therapeutic; predictive value; roc curve; liver hypertrophy; liver weight; respiratory tract disease; receiver operating characteristic; growth rate; venous thromboembolism; volumetry; body surface; hypertrophy; paralytic ileus; portal vein embolization; colon metastasis; humans; prognosis; human; male; female; article; future liver remnant; hepatobiliary parameters; organ growth |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 219 |
| Issue: | 4 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2014-10-01 |
| Start Page: | 620 |
| End Page: | 630 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2014.04.022 |
| PUBMED: | 25158914 |
| PROVIDER: | scopus |
| PMCID: | PMC4171195 |
| DOI/URL: | |
| Notes: | Export Date: 1 December 2014 -- Source: Scopus |
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