Preoperative Portal Vein Embolization before Major Hepatectomy in Patients with Excess Bilirubin does not Affect Hypertrophy of Remnant Liver and Postoperative Outcomes

Abstract

Background/aims: Preoperative portal vein embolization (PVE) has commonly used in patients who were planned major hepatectomy for avoiding the postoperative liver failure. However, the influence of serum bilirubin concentration at the time of PVE on liver regeneration and subsequent surgical outcomes have not been clarified.

Methodology: We retrospectively analyzed 36 patients who scheduled major hepatectomy for hepatobiliary malignancies after PVE. All patients had obstructive jaundice and underwent biliary drainage before PVE. Factors related to hypertrophy ratio of remnant liver volume (RLV) following PVE and postoperative morbidity and mortality were analysed.

Results: Hypertrophy ratio of RLV at 2 weeks after PVE correlated positively with emboli zed liver volume/entire liver volume (ELV) ratio and mean computed tomography attenuation of the liver. RLV/ELV ratio <40% represented the only significant risk factor for postoperative hyperbilirubinemia and mortality after major hepatectomy. Serum bilirubin concentration at the time of PVE did not affect hypertrophy ratio of RLV and postoperative outcomes after major hepatectomy.

Conclusions: PVE in patients with elevated bilirubin levels dose not affect in hypertrophy of remnant liver and postoperative outcomes of subsequent major hepatectomy. Therefore, PVE can perform safely and effectively in patients with obstructive jaundice regardless of serum bilirubin concentration.