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Introduction: Portal vein embolization (PVE) induces hypertrophy of the future liver remnant (FLR) in patients with unfavorable tumor distribution and low calculated standardized FLR (sFLR). We sought to evaluate the safety and efficacy of PVE.
Methods: We evaluated 358 consecutive patients who underwent PVE before intended major hepatectomy from 1995-2012. Diagnoses, morbidity, degree of hypertrophy (DH), and post-PVE resectability were evaluated in the whole study period and compared over time.
Results: The diseases treated included colorectal liver metastases (CLM, 217, 61%), hepatocellular carcinoma (49, 14%), extrahepatic biliary cancers (31, 9%), neuroendocrine metastases (25, 7%), intrahepatic cholangiocarcinoma (13, 3%), and others (23, 6%). Right PVE alone was performed in 31% of cases; due to tumor distribution and to the necessity of resecting segment IV, right PVE with segment IV PVE was required in 66% of patients. The first-session PVE success rate was 98%. Post-PVE complications occurred in 12/358 patients (3%), with portal vein thrombosis occurring in 6 (2%) patients. Median pre-PVE standardized FLR (sFLR) was 19% (inter-quartile range, IQR, 15.0-25.9). Median post-PVE sFLR was 30% (IQR, 22.5-38.2). Of 358 patients who underwent PVE, 282 (79%) were taken to the operating room with 240/358 (67%) undergoing curative hepatectomy. Post-hepatectomy major complications occurred in 62/240 (26%) patients, with postoperative hepatic insufficiency (PHI) in 20/240 (8%) and a 90-day liver-related mortality rate of 9/240 (4%). Over the 18-year study period, the rate of PVE performed for CLM increased from 39% before 2005 to 78% in 2010-12. The use of preoperative chemotherapy and long-duration (>12 weeks) chemotherapy increased from 26% to 86% and from 16% to 43%, respectively, in that time frame (all p<0.001). However, despite increased preoperative chemotherapy usage, PHI and 90-day liver-related mortality rates improved over the last decade (11% and 4%, respectively before 2010 vs. 3% and 3%, in 2010-12).
Conclusions: PVE is safe and effective in inducing hypertrophy in patients with small FLR and allows 2/3 of patients with inadequate FLR the opportunity for curative resection.