Percutaneous portal vein embolization increases the feasibility and safetyof major liver resection for hepatocellular carcinoma in injured liver

Objective To assess the influence of preoperative portal vein embolization (PVE) on t he long-term outcome of liver resection for hepatocellular carcinoma (HCC) in injured liver. Summary Background Data On an healthy liver, PVE of the liver to be resected induces hypertrophy of the remnant liver and increases the safety of hepatectomy. On injured live r, this effect is still debated. Methods During the study period, 10 patients underwent preoperative PVE and 19 pati ents did not before resection of three or more liver segments for HCC in in jured liver (cirrhosis or fibrosis). PVE was performed when the estimated r ate of remnant functional liver parenchyma (ERRFLP) assessed by computed to mographic scan volumetry was less than 40%. Results In all patients, PVE was feasible. There were no deaths or complications. T he ERRFLP after PVE was significantly increased compared with the pre-PVE v alue. Liver resection was performed after PVE in 9 of 10 patients, with sur gical death and complication rates of 0% and 45%, respectively. PVE increas ed the number of resections of three or more segments by 47% (9/19). Overal l actuarial survival rates with or without previous PVE (89%, 87%, and 44% vs. 80%, 53%, and 53% at 1, 3 and 5 years, respectively) and disease-free a ctuarial survival rates (86%, 64%, and 21% vs. 55%, 17%, and 17% at 1, 3, a nd 5 years respectively) after hepatectomy were comparable. Conclusion With the use of PVE, more patients with previously unresectable HCC in inju red liver can benefit from resection. Longterm survival rates are comparabl e to those after resection without PVE.