Background : Portal vein embolization (PVE) is used in preparation for major hepatectomy for patients with insufficient future liver remnant (FLR) to reduce risk of post-hepatectomy liver failure (PHLF). Additional hepatic vein embolization (HVE) and/or segment 4 (S4) portal vein embolization have recently shown to induce further hypertrophy of FLR than PVE alone. There is limited comparison between various liver regenerative techniques. This study aimed to evaluate various liver regenerative strategies for FLR hypertrophy: PVE, PVE/S4 embolization, PVE/HVE, and PVE/HVE/S4 embolization.

Methods : A prospectively maintained hepato-pancreato-biliary (HPB) database at Western Health (2017 - 2023) was used to identify patients with primary or metastatic cancer of the liver; preoperative embolisation approaches; operative interventions; resection rates; and complications. 99mTc-mebrofenin hepatobiliary scintigraphy and CT liver volumetry were used for FLR function and volume assessments.

Results : Of 813 records discussed in the HPB multidisciplinary meetings, 28 patients underwent preoperative embolization/s for colorectal liver metastases (n = 11), Hilar/intrahepatic cholangiocarcinoma (n = 11) and hepatocellular carcinoma (n = 6). 79% were male, and the median age was 64 years. The median FLR hypertrophy was 10.5% post PVE (n = 11/13), 11.3% post PVE/S4 embolization (n = 4), 9.0% post PVE/HVE (n = 4/5), and 9.1% post PVE/HVE/S4 embolization (n = 6). 9 patients received mebrofenin scintigraphy. PHLF was not observed in all 16 major hepatectomy cases.

Conclusions : This is the first Australian study evaluating various embolization techniques for FLR growth to our knowledge. Further studies are needed to assist surgeons in effectively augmenting insufficient FLR before major hepatectomy.