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. 2018 Feb;15(2):1411-1416.
doi: 10.3892/ol.2017.7530. Epub 2017 Dec 5.

Effects of liver cirrhosis on portal vein embolization prior to right hepatectomy in patients with primary liver cancer

Jun-Hui Sun  1 , Yue-Lin Zhang  1 , Chun-Hui Nie  1 , Ju Li  1 , Tan-Yang Zhou  1 , Guan-Hui Zhou  1 , Tong-Yin Zhu  1 , Li-Ming Chen  1 , Wei-Lin Wang  1 , Shu-Sen Zheng  1
Affiliations

Effects of liver cirrhosis on portal vein embolization prior to right hepatectomy in patients with primary liver cancer

Jun-Hui Sun et al. Oncol Lett. 2018 Feb.

Abstract

Preoperative portal vein embolization (PVE) induces compensatory hyperplasia of the future liver remnants (FLR), thus increasing resectability in the non-cirrhotic patients with primary liver cancer (PLC). However, it is unclear if it is similar in patients with liver cirrhosis. Therefore, the present study investigated the PVE value prior to liver resection in patients with PLC, and the liver cirrhotic effects on the compensatory hypertrophy of FLRs following PVE. In the present study, 21 patients with PLC who successfully underwent hepatic resection subsequent to PVE, were retrospectively examined. The patients were divided into a non-cirrhosis group and a cirrhosis group according to the absence or presence of cirrhosis, respectively. The FLR volume between the two groups of patients was compared. There was a significant difference in the FLR volume for all patients prior to, and 4-6 weeks following, PVE (P<0.001). PVE induced significant compensatory hypertrophy in the FLRs whether in the non-cirrhosis group (P=0.002) or cirrhosis group (P<0.001). However, no significant difference was identified between the two groups with respect to FLR volume enlargement 4-6 weeks following PVE (P=0.373). In conclusion, PVE prior to hepatectomy may promote FLR compensatory hypertrophy and an increase in the resectability of PLC tumors. No significant effects of liver cirrhosis were identified on liver lobe hyperplasia following PVE.

Keywords: cirrhosis; embolization; hyperplasia; liver cancer; portal vein.

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Figures

Figure 1.
Figure 1.
Prior to PVE, portal venography demonstrated fluent blood flow in the main portal vein and branches. PVE, preoperative portal vein embolization.
Figure 2.
Figure 2.
Following PVE, portal venography demonstrated that the left branch and main trunk of the portal vein remained smooth. By contrast, the right portal vein branch demonstrated total occlusion. PVE, preoperative portal vein embolization.
Figure 3.
Figure 3.
Prior to PVE, the CT scan revealed a large liver tumor in the right lobe of liver. The right hepatectomy could not be performed due to a shortage of left liver volume. PVE, preoperative portal vein embolization; CT, computed tomography.
Figure 4.
Figure 4.
A total of 4–6 weeks following PVE, the CT scan demonstrated an increased volume of the left lobe and a decreased volume of the right lobe (FLR: From 481.1 to 670 cm3; FLR increase, 39.3%). Coils were identified in the right lobe of the liver (arrow). PVE, preoperative portal vein embolization; CT, computed tomography; FLR, future liver remnants.
Figure 5.
Figure 5.
Peak values of liver function results. (A) ALT, (B) AST, (C) total bilirubin and (D) prothrombin time were similar (P>0.05) prior to PVE, following PVE and prior to surgery, in patients with non-cirrhosis liver and cirrhosis liver. Values are presented as the mean ± standard deviation. PVE, preoperative portal vein embolization; ALT, alanine aminotransferase; AST, aspartate aminotransferase.
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