Portal vein embolization before major hepatectomy.

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology
• Surgical Oncology

Background:

• Major hepatectomy is a complex procedure often limited by insufficient future liver remnant (FLR).
• Portal vein embolization (PVE) is an established technique to induce hypertrophy of the non-ablative liver segments.
• Selecting appropriate candidates for PVE is crucial for optimizing outcomes after major liver resection.

Purpose of the Study:

• To review the rationale, techniques, and unresolved issues of preoperative portal vein embolization (PVE).
• To evaluate the efficacy of PVE in increasing FLR and its impact on postoperative outcomes.
• To discuss the role of PVE in expanding the pool of patients eligible for major hepatic resection.

Main Methods:

• Systematic literature search of PubMed for studies on preoperative PVE before major hepatectomy.
• Review and synthesis of retrieved literature focusing on PVE techniques, patient selection, and outcomes.
• Analysis of data regarding liver hypertrophy, complication rates, and hospital stay post-resection.

Main Results:

• Preoperative PVE induces selective hypertrophy of the non-diseased liver lobe.
• PVE can decrease postoperative complications and shorten hospital stays in selected patients.
• PVE enables surgical resection in patients initially deemed unsuitable due to small FLR, including cirrhotic patients.

Conclusions:

• Preoperative PVE is a valuable approach for selected patients undergoing major hepatectomy.
• PVE can improve outcomes and expand surgical candidacy for liver resection.
• PVE is recommendable for cirrhotic patients requiring major liver resection.