Liver vein deprivation (LVD) is a safe method that induces significant future liver remnant (FLR) growth when compared to portal vein embolization, according to data reported in “Liver Vein Deprivation (LVD) vs. Portal Vein Embolization (PVE): Retrospective Review of Safety and Efficacy.”
The abstract, which is one of the SIR 2022 Featured Abstracts, details researchers’ efforts to assess the safety and efficacy of LVD vs. PVE prior to lobar liver resection.
“Our abstract is meant to highlight the newer (and more aggressive) method of LVD for hepatic augmentation of FLR in patients with primary and secondary liver tumors,” said Aaron McBride, MD, MS. “The abstract compares LVD and portal vein embolization (PVE), demonstrating safety and superior efficacy of LVD.”
According to Dr. McBride, the motivation for the study came from researchers noticing an inadequate increase in the FLR in a significant percentage of patients. “Furthermore, the time needed to achieve adequate FLR for post-resection survival was up to 6–8 weeks and oftentimes led to tumor progression with patients becoming ineligible for surgical resection.”
These findings were corroborated in PVE literature as well. “An alternate surgical option—ALPPS, allows for rapid increase in the FLR; however, it is associated with marked increase in morbidity and mortality,” said Dr. McBride. “These limitations of available IR and surgical options inspired us to research newer techniques for inducing a robust and rapid increase in FLR.”
The single-center retrospective study is a review 45 patients who underwent PVE or LVD prior to lobar liver resection; patients with additional therapies were excluded. The percentage growth of FLR between LVD and PVE procedures was compared, adjusting for age, diabetes, initial FLR and chemotherapy status. Researchers found no significant postprocedural complications noted in either group. As such, preliminary results suggest that LVD is safe.
“Our limited retrospective study shows a statistically significant increase in the FLR with LVD when compared to conventional PVE. Additionally, it is safe in patients who have received extensive chemotherapy as well as for those concurrently receiving chemotherapy,” said Dr. McBride. “With widespread acceptance of this technique, we will be able to make more patients eligible for surgical resection and potentially offer increased survival benefit.”
However, Dr. McBride and the other researchers acknowledge that the retrospective study is limited by small sample size and variations in PVE techniques. “Prospective randomized controlled trials are required to validate these findings before adopting this technique,” said Dr. McBride.
In addition to supporting additional trials, researchers are in the process of applying for a grant to evaluate the kinetic growth rate change in functional status of the FLR after LVD, as well as the survival benefit.
