ArticleHepatobiliary surgery and nutrition2026
Does a patient who needs portal vein embolization (PVE) to proceed to major hepatectomy (MH) have the same hepatic functional reserve than a patient with no preoperative PVE?
Article in Hepatobiliary surgery and nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: While remnant liver function (RLF) gain after portal vein embolization (PVE) was reportedly higher than volume gain, some patients apparently fit for surgery develop post-hepatectomy liver failure (PHLF). This prospective study analyses the hepatic regeneration rates in terms of volume and function following a major hepatectomy (MH) preceded or not by PVE. Methods: Between 2012 and 2018, all non-cirrhotic candidates for MH had a volumetric-computed tomography evaluation and functional-single photon emission computed tomography (SPECT)-scintigraphy of RL preoperatively and postoperatively at day 7 (POD7) and 1 month (1M). RLF was calculated as intrinsic function (i.e., normalized to volume; %/min), and function/volume changes as relative ones (%). We investigated the impact of PVE on post-hepatectomy regeneration rates and related to 3-month outcome (I) in overall population (II) after excluding more risky patients (biliary drainage, severe complications) and (III) in PVE/no-PVE patients matched on remnant liver volume (RLV)/RLF (as the liver regeneration rate is proportional to the extent of resection). Results: Among 136 patients, 125 had one-stage MH, preceded by PVE in 33 patients (26.4%). PVE and no-PVE patients were comparable, except for smaller RLV and more frequent biliary drainages in the former, with higher operating times and blood losses. Preoperative intrinsic RLF was comparable between PVE (0.97%/min; range, 0.81-1.4%/min) and no-PVE groups (1.13%/min; range, 0.92-1.44%/min; P=0.30). At POD7, the volumetric gain was strictly comparable between PVE (+48.7%; range, 36.4-71%; P=0.80) and no-PVE patients (+49.8%; range, 26.8-73.3%), but not the functional gain [+10.7% (range, -3.2% to 42.4%) Conclusions: The current findings showed that some patients apparently fit for surgery after PVE are going to hepatic resection with some degree of disadvantage, displaying lower hepatic reserve and delayed functional recovery than no-PVE patients.
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