S. Yamazaki1, A. Shimizu1, K. Kubota1, T. Notake1, T. Ikehara1, Y. Kuroiwa1, K. Nakamura1, Y. Hongo1, Y. Soejima1 1Shinshu University of Medicine, Division Of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation And Pediatric Surgery, Department Of Surgery, Matsumoto, NAGANO, Japan
Introduction: Patients who are to undergo surgery for perihilar cholangiocarcinoma (PHCC) usually require major hepatectomy, for which attention should be paid to a risk of posthepatectomy liver failure (PHLF). The future remnant liver volume (FRLV) is known as a major factor associated with PHLF and mortality. For patients with small FRLV, portal vein embolization (PVE) is performed to increase the safety of radical major hepatectomy. However, there was no reports to show long-term remnant liver volume (LRV) dynamics after hepatectomy with PVE. The aim this study was to reveal the dynamics of LRV in patients with PHCC who underwent hepatectomy following PVE.
Methods: In 112 patients with PHCC who underwent hepatectomy from August 2004 to August 2021, left hepatectomy and future liver remnant volume (FLRV)/ total liver volume (TLV) ratio ≥ 0.6 were excluded, and finally 55 patients were included; 35 underwent hepatectomy following PVE (PVE group) and 20 underwent hepatectomy without PVE (non-PVE group). Long-term LRV dynamics was compared between the two groups using remnant liver hypertrophy rate (LRV/estimated preoperative FLRV) at the time of one-week, one-, three-, six-month and one-year after hepatectomy. Multivariate analysis was performed to show the independent predictor for remnant liver hypertrophy at one-year after hepatectomy. Optimal cut-off value of remnant liver hypertrophy rate was set as LRV/FLRV≥1.7 using receiver operating characteristics curve analysis.
Results: Age was significantly younger in the PVE group (70 vs 73 years; p<0.001). FLV/TLV before PVE was significantly smaller in the PVE group (0.33 vs 0.45; p<0.001), and FLV/TLV before radical hepatectomy (after PVE) was still smaller in the PVE group without significant difference (0.41 vs 0.45; p=0.07). There was no significant difference in operation time, blood loss, total pringle time, postoperative complications, or application rate of adjuvant chemotherapy. Remnant liver hypertrophy rate at one-month after surgery was significantly smaller in the PVE group (1.53 vs 1.80; p=0.030), whereas there was no significant difference at one-year after surgery (2.09 vs 1.82; p=0.173). Multivariate analysis showed that FLRV/TLV≤0.45(OR 18.87, 95%CI 1.13-333.33; p=0.041) was the only independent predictor of LRV/FLRV≥ 1.7 at one-year after surgery. Additionally, in the PVE group, remnant liver hypertrophy rate at one-year after surgery was significantly lower in patients who developed PHLF compared to patients who did not (1.48 vs 2.11; p=0.012), whereas there was no difference between the patients with and without PHLF in the non-PVE group (1.85 vs 1.82; p=0.889).
Conclusion: Although the short-term LRV hypertrophy was lower in the patients who underwent hepatectomy for PHCC following PVE compared to the patients without PVE, the long-term liver volume was equivalent between the patients with and without PVE.