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Safety and efficacy of preoperative right portal vein embolization in patients at risk for postoperative liver failure following major right hepatectomy

Authors


  • This report is based on an abstract entitled ‘Safety and efficacy of portal vein embolization in patients at risk for postoperative liver failure’, given as a poster presentation during Digestive Disease Week, 7–10 May 2011, Chicago, IL.

Kevin G. Billingsley, Division of Surgical Oncology, Oregon Health and Science University, Mail Code L619, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. Tel: + 1 503 494 5501. Fax: + 1 503 494 7573. E-mail: billingk@ohsu.edu

Abstract

Background:  Right portal vein embolization (RPVE) has been utilized with or without segment IV (RPVE + IV) prior to hepatectomy to induce hypertrophy and prevent liver insufficiency in patients with a predicted future liver remnant (FLR) of ≤30% or cirrhosis.

Methods:  Records of patients who underwent RPVE during 2006–2010 were retrospectively reviewed. Patient demographics, operative outcomes and complications were analysed. Computed tomography-based volumetrics were performed to determine FLR volume and degree of hypertrophy. Patients were stratified by segment IV embolization. Short-term outcomes following RPVE and liver resection are reported.

Results:  A total of 23 patients were identified. Ten patients underwent RPVE and 13 underwent RPVE + IV. The RPVE procedure resulted in a 38% increase in FLR volume. Liver volumes, hypertrophy rates and outcomes were similar in both groups. Rates of operative complications in the RPVE and RPVE + IV groups were similar at 50% and 54%, respectively, and most complications were minor. Complication rates as a result of embolization were 30% in the RPVE group and 31% in the RPVE + IV group. One patient underwent modified operative resection as a result of a complication of RPVE.

Conclusions:  Right portal vein embolization (±segment IV) is a safe and effective modality to increase FLR volume. Post-embolization complications and short-term outcomes after resection are acceptable and are similar in both RPVE and RPVE + IV.

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