A retrospective analysis of portal vein embolisation in a tertiary hepato pancreato biliary centre

Abstract

Background: Liver resection is a treatment for primary and secondary liver tumours that offers a chance of long-term survival. However, the complication of post-operative liver failure as a result of insufficient remnant liver volume with resultant fatality remains a valid concern. The most commonly used technique to overcome this is portal vein embolization (PVE). Material & Methods: A retrospective review of patients in a single tertiary hepato-pancreato-biliary centre who underwent PVE prior to liver resection over a 13-year period. Results: Thirty-five patients were included in the analysis. PVE in practice was a generally safe procedure with serious morbidity (Clavien-dindo III or more) in only 5.7% and no mortality. Following PVE, the average percentage increase in the size of the future liver remnant (FLR) was 32.66% (+/- 31.60) after a mean of 41 days. Tumour progression was evident in 28.6% such that 17.1% failed to undergo liver resection. Following hepatectomy, 13.8% had serious morbidity (Clavien-dindo III or more) with post-operative liver failure in 3.4%. Conclusion: PVE is safe to perform and Results in an increase in the FLR. However, a significant number of patients develop disease progression and fail to progress to liver resection. Other Methods to increase the FLR should be compared to PVE in well conducted randomised controlled trials.