Purpose: To assess the safety and efficacy of liver venous deprivation (LVD - simultaneous hepatic vein with portal vein embolization) before major hepatectomy in heavily pretreated cancer patients.
Materials and Methods: From December 2019 to July 2020, 11 consecutive patients with colon cancer and liver metastasis underwent LVD in a context of small future liver remnant (FLR) (baseline FLR < 30% of the total liver volume) prior to major hepatectomy (4 or more Couinaud segments). Mean age was 56.3 years +/- 9.9 (standard deviation), with 8 men (73%) and 3 women (27%). Mean BMI was 30.2 kg/m2 +/- 4.26 (overweight and obese). Portal vein embolization was performed via trans-splenic approach. Hepatic vein embolization was done from right internal jugular vein approach. The hepatic vein was embolized with Amplatzer plugs and the portal vein with N-butyl cyanoacrylate (NBCA). Prior to LVD, all patients received at least two or more lines of systemic chemotherapy and 9 (82%) had simultaneous hepatic arterial infusion pump chemotherapy. Three-dimensional segmentation volumetry was assessed on CT before LVD and 3-6 weeks after the procedure.
Results: LVD was successful in all patients, with no major peri-procedural or post procedural complications. Major hepatic resection was performed in 9 out of 11 patients (82%). Dropouts were due to tumor progression (n= 1) or insufficient hypertrophy of contralateral liver (n= 1) in a patient with prior history of radiation to the liver, obesity and hepatic steatosis. After LVD, mean FLR hypertrophy was 146% +/- 26. FLR ratio (FLR divided by total liver volume) increased from a mean of 28.33% +/- 8.5 to 41.8% +/- 11.8. Mean daily FLR increase was 8.27 cc/day +/- 4.38 and mean weekly FLR increase was 63.9 cc/week +/- 31.6. Mean kinetic growth rate was 3.38 %/week +/- 2.27. Mean time from procedure to surgery was 48.3 days +/- 26.4.
Conclusion: Liver venous deprivation is a safe and effective procedure that allows FLR hypertrophy in heavily pretreated patients with colorectal cancer liver metastasis. Further studies are needed to confirm these results and compare them to portal vein embolization alone.