Portal vein embolization before liver resection: a systematic review.

Area of Science:

• Interventional Radiology
• Hepatobiliary Surgery
• Oncology

Background:

• Portal vein embolization (PVE) is a critical intervention to induce liver hypertrophy prior to major liver resection.
• Understanding the factors influencing PVE success and subsequent liver regeneration is crucial for optimizing patient outcomes.
• This review synthesizes current literature on PVE indications, techniques, and outcomes.

Purpose of the Study:

• To review the literature regarding the indications, techniques, and outcomes of portal vein embolization (PVE).
• To assess the efficacy and safety of PVE as a preoperative procedure for liver resection.
• To identify factors affecting liver regeneration after PVE.

Main Methods:

• Systematic literature search conducted in Medline, Cochrane, and Embase databases.
• Inclusion of articles published between 1990 and 2011 focusing on the outcomes of PVE.
• Analysis of 44 selected articles encompassing 1,791 patients.

Main Results:

• High overall technical success rate of 99.3% for PVE.
• Mean functional liver remnant (FRL) hypertrophy rate of 37.9%.
• Clinical success rate of 96.1%, with low rates of major complications (2.5%) and mortality (0.1%). Liver cirrhosis negatively impacts hypertrophy response.

Conclusions:

• Preoperative PVE demonstrates high technical and clinical success rates, facilitating liver resection.
• Liver cirrhosis adversely affects liver regeneration post-PVE, while cholestasis and chemotherapy do not significantly influence hypertrophy.
• N-butyl cyanoacrylate may offer a superior hypertrophy response compared to other embolization agents, though not statistically significant.