Combined Portal and Hepatic Vein Embolization Produces Greater Hypertrophy than Portal Vein Embolization Alone with Similar Post-Hepatectomy Outcomes and is not Impacted by Hepatic Artery Infusion Chemotherapy.

BACKGROUND: Combined portal and hepatic vein embolization (cPVE-HVE) induces hypertrophy of future liver remnant before hepatectomy. We compared liver hypertrophy and post-hepatectomy outcomes between cPVE-HVE and portal vein embolization (PVE) alone.

PATIENTS AND METHODS: Consecutive patient outcomes after cPVE-HVE and PVE were compared across all pathologies for degree of hypertrophy (DH), kinetic growth rate (KGR), impact of hepatic artery infusion chemotherapy (HAIC), and post-hepatectomy complications at a single center.

RESULTS: The study cohort included 305 patients, 250 underwent PVE and 55 underwent cPVE-HVE. Pre-embolization future liver remnant (FLR) was 28% versus 32% (p < 0.001) for cPVE-HVE and PVE. Post-embolization DH (11.3% versus 9.4%; p = 0.001) and KGR (3.33% versus 2.29%; p < 0.001) were significantly greater for cPVE-HVE over shorter interval (22 versus 28 days; p = 0.007). HAIC was used in 42% (n = 23) of patients before cPVE-HVE and did not impact hypertrophy. Post-hepatectomy outcomes were similar between cPVE-HVE (n = 38) and PVE (n = 250) cohorts. Rates of transfusion (39% versus 40%; p > 0.9), liver failure (7.9% versus 9.2%, p = 0.6), grade 3-5 complications (42% versus 42%, p > 0.9), 90 day all-cause mortality (5.3% versus 3.6%, p = 0.6), and median hospitalization (7 versus 8 days; p = 0.067) were not significantly different.

CONCLUSIONS: cPVE-HVE was associated with greater hypertrophy than PVE alone, with similar post-hepatectomy outcomes. cPVE-HVE after HAIC was safe with similar hypertrophy. Randomized clinical trial evidence is needed to clearly delineate indication for cPVE-HVE and assess postoperative outcomes.