Objective To assess the efficiency of portal vein embolization (PVE) vs. portal vein ligation (PVL) to induce hypertrophy of the remnant liver before major hepatectomy.
Methods 36 patients with primary or secondary liver tumours and estimated remnant functional liver parenchyma of less than 0,5 % of body weight who underwent occlusion of the right portal branch to induce hypertrophy, were prospectively evaluated. PVE was performed transcutaneously (n=10) or transileocolic (n=8). 18 patients underwent PVL during intraoperativ exploration. Liver volume was assessed by CT scan volumetry.
Results There were no deaths. The morbidity rate was 5% for each group (PVE 1 abscess, PVL 1 bile leak). The mean postoperative hospital stay was significantly shorter in the PVE group with 3,9 ± 2,7 to 8,1 ± 5,1 days after PVL (p<0,01). The estimated rate of remnant functional liver parenchyma increased from 270 ml (217-382) to 420 ml (221-500) in 57 days (36-136) after PVL. Following PVE, contra lateral liver parenchyma increased from 270 ml (58-400) to 434 ml (160-692) 51 days (30-192). Liver volume increased about 184 ml ± 85 ml after PVE and 133 ml ± 51 ml after PVL (p=0,091). Curative liver resection was performed in 11 of 18 patients with PVE (61%) and 12 of 18 patients with PVL (66%).
Conclusions: PVE and PVL are feasible and safety methods to increase the remnant functional liver volume and to archive resectability for extended liver tumours. PVE results in a more efficient increase of liver volume and the shorter hospital stay.
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