Assessment of Segmentary Hypertrophy of Future Remnant Liver after Liver Venous Deprivation: A Single-Center Study

Portal vein embolization, liver venous deprivation (PVE + right hepatic vein embolization) and extended liver venous deprivation (LVD + middle hepatic vein embolization) are three techniques used to induce hypertrophy of the remnant liver prior to a major hepatectomy. To date, the hypertrophy of the different liver segments has never been evaluated. We analyzed results from 44 patients (26 PVE, 10 LVD and 8 eLVD) and found that segments 1 and 2+3 had a greater degree of hypertrophy the more the embolization technique was advanced (eLVD > LVD > PVE). Segment 4's hypertrophy did not seem to be affected by the embolization technique. These findings could help better understand liver hypertrophy and allow for a more personalized approach prior to surgery. Background: Liver venous deprivation (LVD) is a recent radiological technique that has shown promising results on Future Remnant Liver (FRL) hypertrophy. The aim of this retrospective study is to compare the segmentary hypertrophy of the FRL after LVD and after portal vein embolization (PVE). Methods: Patients undergoing PVE or LVD between April 2015 and April 2020 were included. The segmentary volumes (seg 4, seg2+3 and seg1) were assessed before and after the radiological procedure. Results: Forty-four patients were included: 26 undergoing PVE, 10 LVD and 8 eLVD. Volume gain of both segment 1 and segments 2+3 was significantly higher after LVD and eLVD than after PVE (segment 1: 27.33 +/- 35.37 after PVE vs. 38.73% +/- 13.47 after LVD and 79.13% +/- 41.23 after eLVD, p = 0.0080; segments 2+3: 40.73% +/- 40.53 after PVE vs. 45.02% +/- 21.53 after LVD and 85.49% +/- 45.51 after eLVD, p = 0.0137), while this was not true for segment 4. FRL hypertrophy was confirmed to be higher after LVD and eLVD than after PVE (33.53% +/- 21.22 vs. 68.63% +/- 42.03 vs. 28.11% +/- 28.33, respectively, p = 0.0280). Conclusions: LVD and eLVD may induce greater hypertrophy of segment 1 and segments 2+3 when compared to PVE.