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Background: Portal vein embolization (PVE) is utilized in preparation for major hepatectomy to induce hypertrophy and prevent postoperative liver insufficiency. Since 2006 our multidisciplinary team has been using PVE in patients with <30% predicted future liver remnant or underlying liver disease prior to major hepatectomy. This strategy includes embolization of segment IV portal venous branches when an extended right hepatectomy is in the preoperative plan. The aim of this study is to report the short term outcomes following this approach. Methods: Records of patients who underwent PVE during 2006-2010 were retrospectively reviewed. Patient demographics, indications for and extent of resection, operative blood loss, post operative blood product transfusion, length of hospitalization and complications were analyzed. CT based volumetrics were performed to determine future liver remnant (FLR) and standardized future liver remnant (sFLR) volume pre and post-PVE as well as degree of hypertrophy. Patients were stratified by segment IV embolization and compared. Significance was reported for p<0.05.Results: Twenty-three patients were identified. Ten patients underwent PVE without segment IV while 13 patients underwent PVE+IV embolization. Post embolization liver volumes and hypertrophy rates did not differ between the groups (Table 1). The majority of patients in the PVE+IV group underwent extended right hepatectomy while right hepatectomy was more common in the PVE group. Twenty-six percent of patients were resected for an indication other than colorectal cancer. Seventy eight percent of patients received preoperative chemotherapy. Three patients did not undergo resection: two for progression of disease and one for cirrhosis discovered at operation. There was no difference in length of stay, operative blood loss or blood products transfused between groups. Most surgical complications were minor and rates were similar between the PVE and PVE+IV groups at 50% and 54%, respectively. There were no episodes of post-operative liver failure or death. Complication rates from PVE were also similar at 36% among those undergoing PVE vs. 31% for PVE+IV. One patient in the PVE group underwent modified surgical resection due to a complication of portal vein embolization.Conclusions: Portal vein embolization resulted in an overall 38% increase in sFLR volume. Complications related to portal vein embolization occurred but they did not prevent eventual resection. Following embolization, resection was associated with a low incidence of complications.
Table 1. Results of volume analysis.

	PVE (n=10)	PVE+IV (n=13)	p-value
FLR volume pre-PVE (mL)	513.5	440.9	0.305
FLR volume post-PVE (mL)	694.9	579.6	0.123
Change in volume (mL)	144.3	140.9	0.869
sFLR pre-PVE (%)	29.8	24.2	0.283
sFLR post-PVE (%)	42.8	33.6	0.113
Hypertrophy rate (%)	38.9	38.3	0.283