Preoperative right portal vein embolisation: indications and results

The purpose of this retrospective study was to evaluate the efficacy of right portal vein embolisation (PVE) in inducing contralateral liver hypertrophy before extended hepatectomy.

Twenty-six consecutive patients, 14 with liver metastases (ten from colorectal cancer; four from carcinoid tumours) and 12 with biliary cancers (ten Klatskin tumours; one gallbladder tumour; one intrahepatic cholangiocarcinoma) with insufficient predicted future remnant liver (FRL) underwent right PVE to induce hypertrophy of the contralateral hemiliver prior to surgical resection. Total liver volume, tumour volume and FRL volume were calculated on a 3D workstation. The ratio of the FRL to the total functional liver volume was <30% in all patients.

The FRL volume increased by 5%-25% (15% on average) after right PVE in patients with liver metastases and by 9%-19% (14% on average) in patients with biliary cancers. In all patients, the ratio of FRL to functional liver volume was >or=30% after right PVE. No postoperative deaths due to severe liver failure occurred in the 20 patients who underwent extended hepatectomy.

Right PVE extends the indications for hepatectomy in patients with liver metastases and those with biliary cancers who have an insufficient potential hepatic functional reserve.