Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure

Universe Leung, Amber L. Simpson, Raphael L C Araujo, Mithat Gönen, John C. McAuliffe, Michael I. Miga, E. Patricia Parada, Peter J. Allen, Michael I. D'Angelica, T. Peter Kingham, Ronald P. Dematteo, Yuman Fong, William R. Jarnagin

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background After portal vein embolization (PVE), the future liver remnant (FLR) hypertrophies for several weeks. An early marker that predicts a low risk of post-hepatectomy liver failure can reduce the delay to surgery.

Study Design Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional liver volume were measured. Degree of hypertrophy (DH = post-FLR/post-functional liver volume - pre-FLR/pre-functional liver volume) and growth rate (GR = DH/weeks since PVE) were calculated. Postoperative complications and liver failure were correlated with DH, measured GR, and estimated GR derived from a formula based on body surface area.

Results Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7%) and liver failure in 6 patients (3.9%). Nonparametric regression showed that post-embolization FLR percent correlated poorly with liver failure. Receiver operating characteristic curves showed that DH and GR were good predictors of liver failure (area under the curve [AUC] = 0.80; p = 0.011 and AUC = 0.79; p = 0.015) and modest predictors of major complications (AUC = 0.66; p = 0.002 and AUC = 0.61; p = 0.032). No patient with GR >2.66% per week had liver failure develop. The predictive value of measured GR was superior to estimated GR for liver failure (AUC = 0.79 vs 0.58; p = 0.046).

Conclusions Both DH and GR after PVE are strong predictors of post-hepatectomy liver failure. Growth rate might be a better guide for the optimum timing of liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.

Original languageEnglish (US)
Pages (from-to)620-630
Number of pages11
JournalJournal of the American College of Surgeons
Volume219
Issue number4
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

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Liver Failure
Hepatectomy
Portal Vein
Liver
Growth
Area Under Curve
Hypertrophy
Body Surface Area
ROC Curve

ASJC Scopus subject areas

  • Surgery

Cite this

Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure. / Leung, Universe; Simpson, Amber L.; Araujo, Raphael L C; Gönen, Mithat; McAuliffe, John C.; Miga, Michael I.; Parada, E. Patricia; Allen, Peter J.; D'Angelica, Michael I.; Kingham, T. Peter; Dematteo, Ronald P.; Fong, Yuman; Jarnagin, William R.

In: Journal of the American College of Surgeons, Vol. 219, No. 4, 01.10.2014, p. 620-630.

Research output: Contribution to journalArticle

Leung, U, Simpson, AL, Araujo, RLC, Gönen, M, McAuliffe, JC, Miga, MI, Parada, EP, Allen, PJ, D'Angelica, MI, Kingham, TP, Dematteo, RP, Fong, Y & Jarnagin, WR 2014, 'Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure', Journal of the American College of Surgeons, vol. 219, no. 4, pp. 620-630. https://doi.org/10.1016/j.jamcollsurg.2014.04.022
Leung, Universe ; Simpson, Amber L. ; Araujo, Raphael L C ; Gönen, Mithat ; McAuliffe, John C. ; Miga, Michael I. ; Parada, E. Patricia ; Allen, Peter J. ; D'Angelica, Michael I. ; Kingham, T. Peter ; Dematteo, Ronald P. ; Fong, Yuman ; Jarnagin, William R. / Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure. In: Journal of the American College of Surgeons. 2014 ; Vol. 219, No. 4. pp. 620-630.
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abstract = "Background After portal vein embolization (PVE), the future liver remnant (FLR) hypertrophies for several weeks. An early marker that predicts a low risk of post-hepatectomy liver failure can reduce the delay to surgery.Study Design Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional liver volume were measured. Degree of hypertrophy (DH = post-FLR/post-functional liver volume - pre-FLR/pre-functional liver volume) and growth rate (GR = DH/weeks since PVE) were calculated. Postoperative complications and liver failure were correlated with DH, measured GR, and estimated GR derived from a formula based on body surface area.Results Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7{\%}) and liver failure in 6 patients (3.9{\%}). Nonparametric regression showed that post-embolization FLR percent correlated poorly with liver failure. Receiver operating characteristic curves showed that DH and GR were good predictors of liver failure (area under the curve [AUC] = 0.80; p = 0.011 and AUC = 0.79; p = 0.015) and modest predictors of major complications (AUC = 0.66; p = 0.002 and AUC = 0.61; p = 0.032). No patient with GR >2.66{\%} per week had liver failure develop. The predictive value of measured GR was superior to estimated GR for liver failure (AUC = 0.79 vs 0.58; p = 0.046).Conclusions Both DH and GR after PVE are strong predictors of post-hepatectomy liver failure. Growth rate might be a better guide for the optimum timing of liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.",
author = "Universe Leung and Simpson, {Amber L.} and Araujo, {Raphael L C} and Mithat G{\"o}nen and McAuliffe, {John C.} and Miga, {Michael I.} and Parada, {E. Patricia} and Allen, {Peter J.} and D'Angelica, {Michael I.} and Kingham, {T. Peter} and Dematteo, {Ronald P.} and Yuman Fong and Jarnagin, {William R.}",
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T1 - Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure

AU - Leung, Universe

AU - Simpson, Amber L.

AU - Araujo, Raphael L C

AU - Gönen, Mithat

AU - McAuliffe, John C.

AU - Miga, Michael I.

AU - Parada, E. Patricia

AU - Allen, Peter J.

AU - D'Angelica, Michael I.

AU - Kingham, T. Peter

AU - Dematteo, Ronald P.

AU - Fong, Yuman

AU - Jarnagin, William R.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Background After portal vein embolization (PVE), the future liver remnant (FLR) hypertrophies for several weeks. An early marker that predicts a low risk of post-hepatectomy liver failure can reduce the delay to surgery.Study Design Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional liver volume were measured. Degree of hypertrophy (DH = post-FLR/post-functional liver volume - pre-FLR/pre-functional liver volume) and growth rate (GR = DH/weeks since PVE) were calculated. Postoperative complications and liver failure were correlated with DH, measured GR, and estimated GR derived from a formula based on body surface area.Results Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7%) and liver failure in 6 patients (3.9%). Nonparametric regression showed that post-embolization FLR percent correlated poorly with liver failure. Receiver operating characteristic curves showed that DH and GR were good predictors of liver failure (area under the curve [AUC] = 0.80; p = 0.011 and AUC = 0.79; p = 0.015) and modest predictors of major complications (AUC = 0.66; p = 0.002 and AUC = 0.61; p = 0.032). No patient with GR >2.66% per week had liver failure develop. The predictive value of measured GR was superior to estimated GR for liver failure (AUC = 0.79 vs 0.58; p = 0.046).Conclusions Both DH and GR after PVE are strong predictors of post-hepatectomy liver failure. Growth rate might be a better guide for the optimum timing of liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.

AB - Background After portal vein embolization (PVE), the future liver remnant (FLR) hypertrophies for several weeks. An early marker that predicts a low risk of post-hepatectomy liver failure can reduce the delay to surgery.Study Design Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional liver volume were measured. Degree of hypertrophy (DH = post-FLR/post-functional liver volume - pre-FLR/pre-functional liver volume) and growth rate (GR = DH/weeks since PVE) were calculated. Postoperative complications and liver failure were correlated with DH, measured GR, and estimated GR derived from a formula based on body surface area.Results Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7%) and liver failure in 6 patients (3.9%). Nonparametric regression showed that post-embolization FLR percent correlated poorly with liver failure. Receiver operating characteristic curves showed that DH and GR were good predictors of liver failure (area under the curve [AUC] = 0.80; p = 0.011 and AUC = 0.79; p = 0.015) and modest predictors of major complications (AUC = 0.66; p = 0.002 and AUC = 0.61; p = 0.032). No patient with GR >2.66% per week had liver failure develop. The predictive value of measured GR was superior to estimated GR for liver failure (AUC = 0.79 vs 0.58; p = 0.046).Conclusions Both DH and GR after PVE are strong predictors of post-hepatectomy liver failure. Growth rate might be a better guide for the optimum timing of liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.

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