Long-term oncological results of hepatectomies performed after selective portal vein embolization.

Background: selective portal vein embolization (PSPVE), usually of the righ t portal branch, allows some patients to undergo an hepatectomy which was i nitially impossible as it would have left an insuficient amount of liver pa renchyma. PSPVE induces relative atrophy of the embolized part of the liver , inducing compensatory hypertrophy of the non-embolized part (future remai ning liver). Its technical aspects, its tolerance, its immediate results an d indications are currently well-known, but long-term results of PSPVE foll owed by hepatectomy are unknown. The objective of this retrospective study was to assess the long-term survival of this unusual therapeutic approach. Patients and Methods: Forty-one patients with initially unresectable (for v olumetric reasons) malignant lesions of the liver, underwent PSPVE followed by hepatectomy between September 1987 and September 1998. In two-thirds of cases, the primary tumor was a colorectal adenocarcinoma. The mean number of resected lesions was 4.6 per patient, the mean size of the free margin w as 4.3 mm, and 26.8 % of the patients presented a (resectable) extrahepatic tumor. Results: Overall 5-year survival (including the two postoperative d eaths) was 31.3 %, and 5- year survival without recurrence was 24%. For the 27 patients with colorectal metastases (the only homogenous subgroup of th e series), overall 5-year survival was 28.6 %. Although this result was low er than those obtained with classical hepatectomy (34.4 %), it can be consi dered to be satisfactory, due to the number and size of the lesions. Conclu sion : In conclusion, it is justified to use PSPVE to make initially unresp ectable very large liver tumors resectable, in view of the good survival re sults.