Purpose: Among liver hypertrophy technics, liver venous deprivation (LVD) has been recently introduced as an effective procedure to combine simultaneous portal inflow and hepatic outflow abrogation, raising growing clinical interest. The aim of this study is to investigate the role of LVD for preoperative optimization of future liver remnant (FLR) in perihilar cholangiocarcinoma (PHC), especially when compared with portal vein embolization (PVE).Methods: Between January 2013 and July 2022, all patients diagnosed with PHC and scheduled for preoperative optimization of FTR, through radiological hypertrophy techniques, prior to liver resection, were included. FTR volumetric assessment was evaluated at two distinct timepoints to track the progression of both early (T1, 10 days post-procedural) and late (T2, 21 days post-procedural) efficacy indicators. Post-procedural outcomes, including functional and volumetric analyses, were compared between the LVD and the PVE cohorts.Results: A total of 12 patients underwent LVD while 19 underwent PVE. No significant differences in either post-procedural or post-operative complications were found. Post-procedural FLR function, calculated with (99m) Tc-Mebrofenin hepatobiliary scintigraphy, and kinetic growth rate, at both timepoints, were greater in the LVD cohort (3.12 ± 0.55%/min/m2vs. 2.46 ± 0.64%/min/m2,p= 0.041; 27.32 ± 16.86%/week (T1) vs. 15.71 ± 9.82%/week (T1)p< 0.001; 17.19 ± 9.88%/week (T2) vs. 9.89 ± 14.62%/week (T2)p= 0.034) when compared with the PVE cohort. Post-procedural FTR volumes were similar for both hypertrophy techniques.Conclusions: LVD is an effective procedure to effectively optimize FLR before liver resection for PHC. The faster growth rate combined with the improved FLR function, when compared to PVE alone, could maximize surgical outcomes by lowering post-hepatectomy liver failure rates.
目的：在肝脏增生技术中，肝静脉阻断术作为一种结合门静脉流入道与肝静脉流出道同时阻断的有效方法，近期被引入临床并引起日益增长的关注。本研究旨在探讨LVD在肝门部胆管癌术前优化未来剩余肝体积中的作用，特别是与门静脉栓塞术进行比较。 方法：研究纳入了2013年1月至2022年7月期间所有诊断为PHC、计划在肝切除术前通过影像学增生技术进行FTR优化的患者。通过两个不同时间点评估FTR体积变化，以追踪早期（T1，术后10天）和晚期（T2，术后21天）疗效指标的进展。比较LVD组与PVE组术后结果，包括功能性和体积分析。 结果：共有12例患者接受LVD，19例接受PVE。两组在术后及术后并发症方面无显著差异。通过（99m）Tc-甲溴芬宁肝胆闪烁扫描计算的术后FLR功能及两个时间点的动态增长率，LVD组均显著优于PVE组（3.12 ± 0.55%/min/m² vs. 2.46 ± 0.64%/min/m²，p=0.041；27.32 ± 16.86%/周（T1）vs. 15.71 ± 9.82%/周（T1）p<0.001；17.19 ± 9.88%/周（T2）vs. 9.89 ± 14.62%/周（T2）p=0.034）。两种增生技术的术后FTR体积相似。 结论：LVD是PHC肝切除术前有效优化FLR的方法。与单纯PVE相比，更快的增生速率结合改善的FLR功能，可通过降低肝切除术后肝衰竭发生率来最大化手术效果。
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