Portal vein embolization for hepatocellular carcinoma

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology
• Oncology

Background:

• Portal vein embolization (PVE) is crucial for increasing future liver remnant (FLR) volume before major hepatectomy.
• Hepatocellular carcinoma (HCC) patients often have compromised liver function due to viral hepatitis or cirrhosis, complicating PVE indications.
• Sequential procedures, including transarterial chemoembolization, may be necessary to optimize PVE effects and manage tumor progression post-embolization.

Purpose of the Study:

• To evaluate the safety and efficacy of PVE in patients with HCC undergoing major hepatectomy.
• To define optimal patient selection criteria and procedural considerations for PVE in HCC.
• To assess the impact of PVE on FLR hypertrophy and subsequent patient survival.

Main Methods:

• PVE performed in patients with preserved hepatic function (Child-Pugh A, ICG-R15 <20%).
• Strict FLR volume criteria applied: >40% for chronic hepatitis/cirrhosis, >50% for marginal reserve (ICG-R15 10-20%).
• Consideration of sequential therapies like transarterial chemoembolization to enhance PVE outcomes.

Main Results:

• PVE safely induces FLR hypertrophy and atrophy of the resection volume.
• Clinical results indicate PVE is feasible in HCC patients.
• PVE contributes to improved survival following major hepatectomy in this cohort.

Conclusions:

• PVE is a valuable tool for improving the safety of major hepatectomy in HCC patients.
• Careful patient selection and procedural planning are essential for maximizing PVE benefits.
• PVE can lead to better outcomes and survival rates after extensive liver surgery for HCC.