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Left hemi-liver hypertrophy after right portal vein ligation versus embolization: A comparative study
Background
In two-stage hepatectomy (TSH) for bilobar liver metastases from colorectal cancer, future liver remnant (FLR) growth can be achieved using several techniques like right portal vein ligation (RPVL) and right portal vein embolization (RPVE). Few heterogeneous studies (patients, diagnosis, hepatopathy, technical modalities) have compared these two techniques with contradictory results regarding the FLR growth. The objective of this study was to compare the FLR hypertrophy of left hemi-liver (segments I to IV) after RPVL and RPVE in a serie of consecutives patients all treated for colorectal liver metastases (CLM).
Methods
This was a retrospective comparative study using a propensity score of patients who underwent RPVL or RPVE, performed by the same surgeon and radiologist, prior to major hepatectomy between january 2009 and december 2020. Patients treated for another malignancies than CLM were exclued as patients with history of liver resection of 1 segment or more, alcohol injection prior to RPVL and ALPPS. Volumetrics data were recaculated using OsiriX (Pixmeo™) by one surgeon to objective the hypertrophy of the segments I to IV whatever the final procedure performed. The endpoint was the FLR growth (%) post-RPVL/RPVE and the FLR/Bodyweight ratio after ponderation with propensity score for : FLR prior to surgery and number of chemotherapy. Duration between RPVL/RPVE and post-operative computed tomography (CT) was also test to objective the impact on the FLR growth. The potentials factors influencing liver hypertrophy described in the literature were analysed in our serie of patients. They were included in the propensity score if a difference of 20% or more between the two groups was found in univariate analysis. The propensity score was build using the stabilized inverse probability of treatment weighting (SIPTW). Duration between RPVL/RPVE and post-operative CT was analysed using a linear regression model before and after ponderation. The limit for statistical significance was set at p < 0,05.
Results
During the period, 54 patients were retrospectively included and analysed, 18 in the RPVL group and 36 in the RPVE group. The demographic characteristics were similar between the groups. In the RPVL group, 17 patients (94,4%) were treated during the same general anesthesia for left hemi-liver metastases, primary tumour or both. In the RPVE group, 3 patients (8,3%) were also treated for left hemi-liver metastases during another procedure. After ponderation the FLR growth of the left hemi-liver was not significantly different between the two groups as the FLR/Bodyweight ratio. The median FLR growth was 32,5% [19,3, 56,0] in the RPVL group and 34,5% [20,5, 47,3] in the RPVE group, p=0,859. The duration between RPVL/RPVE and post-operative CT was not significantly associated with FLR growth in our study.
Conclusions
RPVL and RPVE are still both interesting and equivalent in order to achieve left hemi-liver hypertrophy in TSH for multiple bilobar metastases from colorectal cancer. RPVL should be considered in the simulatenous treatment of bilobar liver metastases and primary tumour especially since this technique can be performed with laparoscopy.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
