Hepatectomy for patients with transient hepatic failure after preoperative portal vein embolization

Portal vein embolization (PVE) is a preparative procedure to facilitate major hepatectomy. Most patients with various hepatobiliary diseases were tolerable to right PVE. However, a few patients revealed marked deterioration of liver function after PVE, which made surgeons hesitate whether to carry out preplanned major hepatectomy. We report 2 cases of right liver resection after an episode of PVE-induced transient liver failure. The first patient was a 42-year-old male who had hepatocellular carcinoma in the cirrhotic liver background. After right PVE, serum aspartate and alanine aminotransferases raised to 1222 IU/L and 1908 IU/L, respectively. His liver function improved very slowly, and right lobectomy could be performed after waiting of 46 days. Postoperative restoration of liver function was also delayed, but he recovered after all. The second patient was a 53-year-old male with intrahepatic cholangiocarcinoma without jaundice. Serum total bilirubin rose to 10.7 mg/dL after right PVE, and decreased slowly. Right lobectomy was carried out after waiting of 45 days and postoperative course was uneventful. Meticulous liver transection without interruption of hepatic inflow, early infusion of gabexate mesilate, and intraportal infusion of glucose-insulin-potassium solution were adopted to protected the remnant liver. We think that transient liver failure after PVE is not contraindicated for major hepatectomy if there is no definite causal risk factor, but every effort should be paid to prevent posthepatectomy liver failure.