ALCOLIZZAZIONE ASSOCIATA ALLA LEGATURA PORTALE: UNA TECNICA EFFICACE PER INCREMENTARE LA RIGENERAZIONE EPATICA

BACKGROUND AND AIM: Portal vein occlusion by ligation (PVL) or embolization (PVE) is routinely performed to increase inadequate future liver remnant volume (FLRV) . The higher liver regeneration rate observed after PVE than after PVL may be due to the formation in the latter of intrahepatic porto-portal collaterals between the portal branches of segment 4 and the branches of the adjacent right segments 5 and 8. The aim of the study was to compare liver regeneration rate following portal vein ligation (PVL) with (Alc+) and without (Alc-) simultaneous intraportal alcohol injection METHODS: Forty-two patients with colorectal liver metastases who underwent PVL between January 2004 and June 2014 were analyzed. Beginning in September 2011, absolute alcohol was injected prior to right PVL. Future liver remnant volume (FLRV) was assessed by CT-scan. CT-scans were reviewed to assess recanalization and/or cavernous transformation of the occluded portal vein. Liver regeneration was assessed as Volumetric Increase (VI) [(FLRVpost% – FLRVpre%)/FLRVpre%]. RESULTS: The Alc+ (n=23) and Alc- (n=19) groups were similar in age, sex, diabetes, pre-PVL FLRV and administration of chemotherapy. The rate of recanalization of the occluded portal vein was significantly higher (63.1% vs. 4.3%, p<0.001) and the rate of cavernous transformation higher (36.8% vs. 8.7%, p=0.055) in the Alc- than in the Alc+ group. Post-PVL FLRV (43.3±14.3% vs. 34.6±6.4%, p=0.013) and VI (0.44±0.24 vs. 0.28±0.20, p=0.029) were significantly higher in the Alc+ group. Univariate analysis showed that male sex (0.23±024 vs.0.40±0.19, p=0.005) and PVL without alcohol injection (0.35±0.24 vs. 0.26±0.20, p=0.035) were negatively correlated with VI. Multiple regression analysis showed that male sex (B=−0.149, p=0.035) and alcohol injection (B=0.143 p=0.041) significantly predicted VI [F(1,40)=5.200, p=0.010]. CONCLUSIONS: Alcohol injection prior to PVL significantly increased regeneration rate of the future liver remnant, reducing recanalization of the occluded portal vein.