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A Nomogram to Predict Hypertrophy of Liver Segments 2 and 3 After Right Portal Vein Embolization
Guillaume Passot*1, Yoshihiro Mise1, Xuemei wang2, Hsiang-Chun Chen2, Kristoffer W. Brudvik1, Thomas Aloia1, steven huang3, Jean-Nicolas Vauthey1
1Surgical Oncology, MD Anderson, Houston, TX; 2Biostatistics, MD Anderson, Houston, TX; 3Interventional radiology, MD Anderson, Houston, TX
Background: Portal vein embolization (PVE) reduces the risks of hepatic insufficiency after major hepatectomy. The extent of liver hypertrophy after PVE depends on various clinical factors. We sought to develop a nomogram for predicting the increase in the volume of segments 2 and 3 after right PVE (RPVE).
Method: In 360 patients who underwent RPVE from 1998 through 2013, clinicopathologic data were analyzed, including body mass index (BMI), diabetes, aspirin use, viral hepatitis status, preoperative albumin level, total bilirubin level, prothrombin time, platelet count, type of liver neoplasm, preoperative chemotherapy, previous laparotomy or hepatectomy, segment 4 embolization, 2-stage hepatectomy, and liver volumes before and after PVE. Multivariate linear regression analysis was used to identify variables predicting the degree of hypertrophy of segments 2 and 3.
Results: Multivariate regression analysis revealed that BMI (p=0.002), previous hepatectomy (p=0.03), RPVE in the setting of 2-stage hepatectomy (p<0.001), and segment 4 embolization (p=0.003) independently predicted the degree of hypertrophy of segments 2 and 3. Based on the fitted model, a nomogram was constructed.
Conclusion: The constructed nomogram predicts the degree of hypertrophy of segments 2 and 3 after RPVE and can be used in clinical decision making for patients undergoing right hepatectomy.
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