Comparison of Liver Venous Deprivation and Portal Vein Embolization for Future Liver Remnant Hypertrophy: A Single-Center Retrospective Study

Aim: This study aimed to compare the safety, feasibility, and efficacy of liver venous deprivation (LVD) and portal vein embolization (PVE) in inducing future liver remnant (FLR) hypertrophy prior to major hepatectomy. Method: In this retrospective single-center study, 38 patients who underwent PVE (n=29) or LVD (n=9) between June 2020 and January 2025 were analyzed. Patients were selected based on small FLR volume requiring preoperative hypertrophy induction. Pre- and post-procedural liver volumetric measurements were performed using contrast-enhanced CT, and standardized FLR (sFLR) percentages were calculated. Clinical outcomes, including postoperative complications and mortality, were also evaluated. Results: Among 38 patients, 21 (15 PVE and 6 LVD) proceeded to surgery. Although pre-procedural sFLR percentages were similar between groups (19.5±2.0% for PVE vs. 19.9±2.6% for LVD; p=0.806), post-procedural sFLR percentages were significantly higher in the LVD group (33.4±5.1% vs. 24.5±5.1%, p=0.012). The mean degree of standardized FLR hypertrophy, expressed as an absolute percentage point increase was significantly greater in the LVD group (13.5% vs. 5%, p=0.009), and the percentage FLR increase was higher (68.6±20.7% vs. 24.7±15.6%, p=0.006). No significant differences were observed in postoperative complication rates (16.6% vs. 20%, p=0.601) or mortality (16.7% vs. 13.3%, p=0.847). Conclusion: LVD demonstrated superior FLR hypertrophy compared to PVE while maintaining a comparable safety profile. LVD may offer an effective alternative for patients with small baseline FLR volumes at high risk of insufficient liver regeneration. Further prospective studies are warranted to confirm these findings and define the optimal clinical indications for LVD.