An observational study to determine volume changes in the functional liver remnant following portal vein embolization

Background and Aim: Portal vein embolization (PVE) prior to hepatic resection reduces the risk of hepatic insufficiency in the postoperative period by redistributing blood from the embolized unhealthy liver to the healthy liver, termed the functional liver remnant (FLR). A retrospective analysis of liver volumes after embolization in a single institution was performed to identify change in volume of the FLR and determine factors affecting this change. Methods: Between 2013 and 2015, 21 patients undergoing PVE followed by hepatic resection for varied indications (colorectal metastases, hepatocellular carcinoma, cholangiocarcinoma, etc.) were included in this study. n-butyl cyanoacrylate glue diluted with Lipiodol (35-45% strength) along with 75-100 mu m of polyvinyl alcohol particles were used for embolization. Liver volumetric determination was performed before and after PVE and volume changes in the FLR were analyzed. Biochemical factors and factors affecting FLR hypertrophy were also analyzed. Results: Majority of the patients (n = 18) underwent right-lobe embolization. All were performed using the ipsilateral approach. No major complications occurred with only one patient developing post-procedural ascites requiring percutaneous draining. A significant increase in the mean volume of the FLR by 63.7% +/- 91.6%, P = 0.001 was noted after PVE. The FLR/total liver volume (TLV) increased significantly by 17% +/- 18%. No significant demographic factors affected FLR hypertrophy and no significant biochemical changes were noted. Thirteen patients were successfully operated on after embolization. Conclusions: PVE is effective in inducing significant hypertrophy of the future FLR, prior to hepatic resection in our institution.