Journal of Gastrointestinal Surgery

, Volume 18, Issue 1, pp 45–51

Safety and Efficacy of Portal Vein Embolization Before Planned Major or Extended Hepatectomy: An Institutional Experience of 358 Patients

  • Junichi Shindoh
  • Ching-Wei D. Tzeng
  • Thomas A. Aloia
  • Steven A. Curley
  • Steven Y. Huang
  • Armeen Mahvash
  • Sanjay Gupta
  • Michael J. Wallace
  • Jean-Nicolas Vauthey
2013 SSAT Plenary Presentation

Abstract

Introduction

Portal vein embolization (PVE) stimulates hypertrophy of the future liver remnant (FLR) and may improve the safety of extended hepatectomy. The efficacy of PVE was evaluated.

Methods

Records of 358 consecutive patients who underwent PVE before intended major hepatectomy at our institution from 1995 through 2012 were retrospectively reviewed.

Results

One hundred twelve patients (31.3 %) had right PVE alone; 235 (65.6 %) had right PVE plus segment IV embolization. The first-session PVE completion rate was 97.8 %. The PVE complication rate was 3.9 %. The median pre-PVE and post-PVE standardized FLRs were 19.5 % (interquartile range, 15.0–25.9) and 29.7 % (interquartile range, 22.5–38.2), respectively. Two hundred forty patients (67.0 %) underwent potentially curative resection. Sixty-two patients (25.8 %) had major post-hepatectomy complications; rates of postoperative hepatic insufficiency and 90-day liver-related mortality were 8.3 and 3.8 %, respectively. The proportion of patients with colorectal liver metastasis increased from 38.6 % before 2005 to 78.2 % in 2010–2012. Despite increased use of preoperative chemotherapy, postoperative hepatic insufficiency and 90-day liver-related mortality rates dropped from 10.6 and 4.1 %, respectively, before 2010 to 2.9 and 2.9 %, respectively, in 2010–2012.

Conclusions

PVE can be safely performed with minimal morbidity. Most patients can proceed to extended hepatectomy, which is associated with a minimal mortality rate.

Keywords

Portal vein embolization Future liver remnant Extended hepatecotmy Hepatic insufficiency 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Junichi Shindoh
    • 1
  • Ching-Wei D. Tzeng
    • 1
  • Thomas A. Aloia
    • 1
  • Steven A. Curley
    • 1
  • Steven Y. Huang
    • 2
  • Armeen Mahvash
    • 2
  • Sanjay Gupta
    • 2
  • Michael J. Wallace
    • 2
  • Jean-Nicolas Vauthey
    • 1
  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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