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ANZ J Surg. 2014 May;84(5):341-5. doi: 10.1111/ans.12016. Epub 2012 Dec 12.

Portal vein embolization prior to major liver resection.

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  • 1Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, The University of Sydney, Sydney, New South Wales, Australia.

Abstract

BACKGROUND:

Portal vein embolization (PVE) induces compensatory hypertrophy of the future liver remnant volume (FLRV) to improve the safety of major liver surgery by reducing the risk of post-operative liver failure. The aim was to describe our experience of PVE for patients with large or multifocal malignant liver tumours who initially were deemed unresectable.

METHODS:

Perioperative data were retrieved from a prospective database and computed tomographic scans were retrospectively reviewed to calculate volume changes and the degree of liver hypertrophy following PVE.

RESULTS:

PVE was successful in 23 out of 25 patients and resulted in a change in the mean estimated FLRV from 585 to 788 mL following PVE. This represented a 35% increase in the remnant liver parenchymal volume post-embolization (P < 0.01). The procedure was well tolerated and did not compromise the surgical resection in any patient. Nineteen patients went on to have a liver resection following PVE with an in-hospital mortality of 16% (3 out of 19) and a 42% morbidity rate. After a mean follow-up of 31 months (1-130 months), 32% (6 out of 19) of patients are alive and 4 of these (21%) are completely disease-free.

CONCLUSIONS:

PVE results in an increase in the FLRV prior to major hepatectomy. Failure to develop hypertrophy following PVE is a surrogate marker for underlying liver dysfunction. PVE is safe and may increase the pool of patients suitable for liver resection. Long-term survival is similar to those not requiring embolization prior to liver resection.

© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

KEYWORDS:

future liver remnant volume; hepatectomy; liver hypertrophy; liver tumour; portal vein embolization

PMID:
23231008
[PubMed - indexed for MEDLINE]
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