Preoperative portal vein embolization for liver malignancies

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology
• Surgical Oncology

Background:

• Extensive liver resection for primary or secondary liver malignancies often requires a sufficient future remnant liver (FRL) volume.
• A small FRL (<30%) poses a significant risk of postoperative liver failure, limiting surgical options.
• Preoperative portal vein embolization (PVE) is a technique to induce hypertrophy of the FRL.

Purpose of the Study:

• To evaluate the effectiveness and safety of right portal vein embolization (PVE) prior to extensive liver resection.
• To assess the impact of PVE on FRL volume and the subsequent risk of postoperative hepatic failure.

Main Methods:

• Retrospective analysis of 24 patients undergoing right PVE between 1997 and 2003 for planned extensive liver resection.
• Indications included FRL <30% of total liver volume.
• Ultrasound-guided percutaneous transhepatic puncture and embolization of the right portal vein using various agents (Lipiodol, ethanol, coils).

Main Results:

• PVE was technically simple and complication-free in all patients.
• Significant FRL hypertrophy observed (mean 40% increase) within 19-56 days, raising FRL from 25% to 35%.
• Of 15 patients undergoing hepatectomy, 11 (79%) had no postoperative liver failure; only one patient with initially insufficient FRL died from liver failure.

Conclusions:

• Right portal vein embolization is a safe and effective procedure to increase FRL volume.
• PVE significantly reduces the risk of postoperative hepatic failure following major liver resection.
• This technique expands the possibility of curative resection for patients with extensive liver malignancies.