REGENERATION OF THE UN-EMBOLIZED LIVER PARENCHYMA FOLLOWING PORTAL-VEIN EMBOLIZATION

Background/Aims: Portal vein embolization (PVE) induces atrophy of the embolized hepatic parenchyma and hypertrophy of the un-embolized live r, It is important to predict hypertrophy of un-embolized liver follow ing PVE to decide a subsequent tactics in patients with liver tumors, The hypertrophy following PVE was evaluated in reference to embolized liver volume and a preceding use of transcatheter hepatic arterial che moembolization (HACE) in this study. Methods: Thirty patients with liv er tumors were studied, PVE was performed transhepatically, Ethanol (1 5-65 ml) was injected into portal veins, which perfused the liver segm ent bearing the tumor until occlusion, Embolization was performed at s ubsegmental portal branches in five patients, segmental branches in 11 patients and right portal veins in 14 patients, Twenty-three patients with underlying chronic liver disease and hepatocellular carcinoma (H CC) underwent PVE 2-6 weeks after HACE. The remaining seven patients w ithout underlying chronic liver disease had bile duct cancer (6) or li ver metastasis (1), and underwent PVE alone, Segmental volume in the l iver was measured with computed tomography before and 4 weeks after PV E. Results: The degree of hypertrophy showed a significant correlation with embolized liver volume (r = 0.685, p<0.001). Increase in un-embo lized liver volume was 2.4+/-5.8% with subsegmental embolization (NS), 15.2+/-6.4% with segmental embolization (p<0.01) and 46.5+/-18.8% wit h right PVE (p<0.001). In 14 patients with right PVE, degree of hypert rophy in seven patients with HACE was greater than that in seven patie nts without HACE (56.7+/-21.6% vs 36.4+/-7.4%; p<0.03). Conclusions: H ypertrophy of the un-embolized liver parenchyma following PVE was corr elated with embolized liver volume and was augmented with combined use of HACE.