review · Frontiers in Medicine
Major liver surgery often requires sufficient remaining liver tissue to ensure patient survival, prompting pre-operative procedures to stimulate liver growth. This systematic review and meta-analysis evaluated nine comparative studies covering 557 patients to assess liver venous deprivation against the standard technique of portal vein embolization before major hepatectomy. The analysis established that liver venous deprivation led to higher future liver remnant volume, faster kinetic growth, and lower rates of resection failure caused by inadequate remaining tissue. It also resulted in higher day five prothrombin times and improved three-year disease-free survival. Complication rates, post-operative morbidity, hospital length of stay, and overall three-year survival showed no meaningful differences between the two methods, indicating that liver venous deprivation is a safe and feasible alternative that can expand surgical eligibility.
When patients require surgical removal of large portions of the liver, the remaining tissue must be large enough to function safely. By showing that liver venous deprivation triggers faster and greater liver growth without raising surgical complications, these findings provide evidence to help surgeons successfully qualify more patients with borderline liver volumes for life-saving operations.
The findings are relevant to clinical teams, interventional radiologists, and surgical units planning liver resections. Because the analysis synthesises comparative clinical data from over five hundred patients, the techniques are already applied and tested in healthcare practice. The abstract does not indicate any direct product development or commercialisation pathway.
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Introduction This systematic review aimed to compare liver venous deprivation (LVD) with portal vein embolization (PVE) in terms of future liver volume, postoperative outcomes, and oncological safety before major hepatectomy. Methods We conducted this systematic review and meta-analysis following the PRISMA guidelines 2020 and AMSTAR 2 guidelines. Comparative articles published before November 2022 were retained. Results The literature search identified nine eligible comparative studies. They included 557 patients, 207 in the LVD group and 350 in the PVE group. This systematic review and meta-analysis concluded that LVD was associated with higher future liver remnant (FLR) volume after embolization, percentage of FLR hypertrophy, lower failure of resection due to low FLR, faster kinetic growth, higher day 5 prothrombin time, and higher 3 years’ disease-free survival. This study did not find any difference between the LVD and PVE groups in terms of complications related to embolization, FLR percentage of hypertrophy after embolization, failure of resection, 3-month mortality, overall morbidity, major complications, operative time, blood loss, bile leak, ascites, post hepatectomy liver failure, day 5 bilirubin level, hospital stay, and three years’ overall survival. Conclusion LVD is as feasible and safe as PVE with encouraging results making some selected patients more suitable for surgery, even with a small FLR. Systematic review registration The review protocol was registered in PROSPERO before conducting the study (CRD42021287628).
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DOI: 10.3389/fmed.2023.1334661
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