Björk Dennis, Carling Ulrik, Gilg Stefan, Hasselgren Kristina, Larsen Peter N, Lindell Gert, Røsok Bård I, Sandström Per, Sturesson Christian, Tschuor Christoph, Sparrelid Ernesto, Björnsson Bergthor
Department of Surgery in Linköping and Institution for Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Department of Radiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
Eur J Surg Oncol. 2025 Jul;51(7):109995. doi: 10.1016/j.ejso.2025.109995. Epub 2025 Mar 22.
Portal vein embolization (PVE) may be used to induce hypertrophy of the future liver remnant (FLR) before major hepatectomy. The influence of hyperbilirubinemia on FLR hypertrophy after PVE is controversial. The aim of this study was to compare FLR hypertrophy after PVE between patients with and without elevated P-bilirubin.
MATERIALS/METHODS: This is a Scandinavian retrospective cohort study of patients from five hepatobiliary centres. This study included patients who underwent right-sided PVE from 2013 to 2023. Data were collected from electronic medical records. FLR growth was analysed with respect to normal or elevated P-bilirubin.
In total, 410 patients were included in this study. Among the total cohort, 105 patients had elevated P-bilirubin levels (≥26 μmol/L) at the time of PVE. Elevated P-bilirubin levels were not associated with impaired FLR hypertrophy after PVE, as determined by absolute growth (p < 0.001), relative growth (p = 0.008), degree of hypertrophy (p < 0.001) and kinetic growth rate (p = 0.002). Multivariable analysis revealed that elevated P-bilirubin levels at the time of PVE (p = 0.002) together with the use of N-butyl cyanoacrylate (NBCA) as an embolizing material (p = 0.009) were associated with increased FLR hypertrophy. A larger estimated total liver volume was associated with reduced FLR hypertrophy (p < 0.001).
In this multicentre, retrospective cohort study, we were unable to show any negative effect of elevated P-bilirubin on FLR hypertrophy at the time of PVE. There is no need for P-bilirubin levels to normalize before PVE. This study supports the ongoing shift towards NBCA as an embolizing material.
门静脉栓塞术（PVE）可用于在大型肝切除术前诱导未来肝残余量（FLR）肥大。高胆红素血症对PVE后FLR肥大的影响存在争议。本研究的目的是比较PVE后胆红素水平升高和未升高的患者的FLR肥大情况。
材料/方法：这是一项对来自五个肝胆中心患者的斯堪的纳维亚回顾性队列研究。本研究纳入了2013年至2023年接受右侧PVE的患者。数据从电子病历中收集。分析了正常或升高的胆红素水平下FLR的生长情况。
本研究共纳入410例患者。在整个队列中，105例患者在PVE时胆红素水平升高（≥26 μmol/L）。根据绝对生长（p < 0.001）、相对生长（p = 0.008）、肥大程度（p < 0.001）和动态生长率（p = 0.002）确定，胆红素水平升高与PVE后FLR肥大受损无关。多变量分析显示，PVE时胆红素水平升高（p = 0.002）以及使用氰基丙烯酸正丁酯（NBCA）作为栓塞材料（p = 0.009）与FLR肥大增加有关。估计的全肝体积越大，FLR肥大越小（p < 0.001）。
在这项多中心回顾性队列研究中，我们未能显示PVE时胆红素水平升高对FLR肥大有任何负面影响。在PVE前无需使胆红素水平正常化。本研究支持正在向使用NBCA作为栓塞材料的转变。
