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Title: Prediction of the remnant liver hypertrophy ratio after preoperative portal vein embolization.
Authors: Kasai, Y
Hatano, E
Iguchi, K
Seo, S  kyouindb  KAKEN_id
Taura, K  kyouindb  KAKEN_id
Yasuchika, K  kyouindb  KAKEN_id
Mori, A
Kaido, T
Tanaka, S  kyouindb  KAKEN_id  orcid (unconfirmed)
Shibata, T
Uemoto, S  kyouindb  KAKEN_id
Author's alias: 笠井, 洋祐
波多野, 悦朗
Keywords: Portal vein embolization
Hypertrophy ratio
Major hepatectomy
Associating liver partition and portal vein ligation for staged hepatectomy

Issue Date: Feb-2013
Publisher: Karger
Journal title: European surgical research. Europäische chirurgische Forschung. Recherches chirurgicales européennes
Volume: 51
Issue: 3-4
Start page: 129
End page: 137
Abstract: Background: Portal vein embolization (PVE) is considered to improve the safety of major hepatectomy. Various conditions might affect remnant liver hypertrophy after PVE. The aim of the present study was to clarify the factors that affect remnant liver hypertrophy and to establish a prediction formula for the hypertrophy ratio. Methods: Fifty-nine patients who underwent preoperative PVE for cholangiocarcinoma (39 patients), metastatic carcinoma (10 patients), hepatocellular carcinoma (8 patients), and other diseases (2 patients) were enrolled in this study. For the prediction of the hypertrophy ratio, a formula with stepwise multiple regression analysis was set up. The following parameters were used: age, gender, future liver remnant ratio to total liver (FLR%), plasma disappearance rate of indocyanine green (ICGK), platelet count, prothrombin activity, serum albumin, serum total bilirubin at the time of PVE and the maximum value before PVE (Max Bil), as well as a history of cholangitis, diabetes mellitus, and chemotherapy. Results: The mean hypertrophy ratio was 28.8%. The 5 parameters detected as predictive factors were age (p = 0.015), FLR% (p < 0.001), ICGK (p = 0.112), Max Bil (p < 0.001), and history of chemotherapy (p = 0.007). The following prediction formula was established: 101.6 - 0.78 × age - 0.88 × FLR% + 128 × ICGK - 1.48 × Max Bil (mg/dl) - 21.2 × chemotherapy. The value obtained using this formula significantly correlated with the actual value (r = 0.72, p < 0.001). A 10-fold cross validation also showed significant correlation (r = 0.62, p < 0.001), and a hypertrophy ratio <20% was predictable with a sensitivity of 100% and a specificity of 90.9%. Moreover, technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin scintigraphy showed a significantly smaller increase in the uptake ratio of the remnant liver in patients with prediction values <20% than in those with values ≥20% (6.8 vs. 20.8%, p = 0.030). Conclusions: The prediction formula can prognosticate the hypertrophy ratio after PVE, which may provide a new therapeutic strategy for major hepatectomy.
Rights: © 2014 S. Karger AG, Basel
この論文は出版社版でありません。引用の際には出版社版をご確認ご利用ください。This is not the published version. Please cite only the published version.
DOI(Published Version): 10.1159/000356297
PubMed ID: 24280661
Appears in Collections:Journal Articles

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