Portal Vein Embolization: History and Current Indications

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology
• Oncology

Background:

• Portal vein embolization (PVE) was initially developed for patients undergoing major hepatectomy for hepatocellular carcinoma (HCC).
• PVE stimulates hypertrophy of the non-embolized liver segments, increasing the future liver remnant (FLR) to total liver volume ratio.
• Hepatic function shifts to the non-embolized liver portion, as confirmed by 99mTc-GSA scintigraphy.

Purpose of the Study:

• To evaluate the efficacy and safety of PVE in expanding indications for major hepatectomy.
• To assess PVE's role in managing patients with insufficient FLR volume or function.
• To identify predictive factors for PVE efficacy and its utility as a tolerance test.

Main Methods:

• PVE procedure for inducing liver hypertrophy and functional shift.
• Assessment of FLR volume and liver function using volumetric analysis and 99mTc-GSA scintigraphy.
• Correlation analysis between histologic inflammatory activity, serum 7s collagen levels, and FLR volume increase.

Main Results:

• PVE successfully increased FLR volume and induced a functional shift in the liver.
• PVE is increasingly used to enable major hepatectomy in patients with initially inadequate FLR.
• Negative correlation between histologic inflammatory activity and FLR volume increase; high serum 7s collagen (>8 ng/ml) predicts poor PVE efficacy.

Conclusions:

• PVE is a safe and effective treatment for patients undergoing major hepatectomy, particularly for HCC.
• PVE serves as a valuable tool to predict tolerance to major hepatectomy and prevent postoperative hepatic failure.
• PVE improves long-term survival outcomes in patients with HCC undergoing liver resection.