[Portal vein embolization--increased chance for liver resecability for malignancies]

Liver surgery for liver malignancy is recently limited not by technical possibilities but by physiological reserves of liver parenchyma. Portal vein embolization (PVE) is performed to increase future liver remnant volume (FLRV) to extend the possibilities of liver resections. The authors evaluate the cohort of patients, that underwent PVE and confront them with the cohort of patients that underwent liver resection without PVE.

At the Department of Surgery and Departement of Radiology, University Hospital Pilsen there were performed successfully PVE at 24 patients between January 2001 and August 2006. The increase of FLRV was sufficient at 17 patients. The mean period between PVE and computed tomography volumetry was 29 days. The mean period between PVE and surgical procedure was 54 days. 8 patients underwent radical liver surgery (right hepatectomy, extended right hepatectomy, combination of right hepatectomy with RFA in left lobe), 3 patients underwent radiofrequency ablation, the rest of patients was explored. For comparison we used cohort of 107 patients that underwent one step radical surgery for malignancy.

1 year survival rate after liver operation was 85.7%, 3 years survival rate 42.9%. Disease free interval (DFI) was counted only for group of radicaly operated patients. One year DFI was 40%, two year DFI was 20%. The number of leasions was not proved as statistically significant for DFI or survival rate. In non PVE group 1 year survival rate was 78.9%, 3 years survival rate was 34.0%, one year DFI was 60.2%, two years DFI was 36.6%.

The survival rate was higher in PVE group, the DFI was shortened in PVE group. In our cohort we could conclude, the PVE increase survival rate instead of shortened DFI. PVE spreads possibilities for liver resections at patients with small FLVR and enables radical surgical therapy for patients, that will be leaved a palliative surgery or oncological therapy.