Effectiveness of preoperative selective portal vein embolization before extensive hepatic resection.

Abstract

B ecause of the hepatotrophic properties of portal flow,' preoperative selective portal vein embolization (PSPVE) may be a safe method to induce atrophy of the embolized portion of liver before resection and a compensatory hypertrophy in the future remnant liver. This technique recently has become important in the preoperative management of patients who must undergo extensive liver resection,2-4 improving operability and avoiding life-threatening postoperative liver failure5~~ when there is a risk for insufficient remaining liver parenchyma after surgery. In clinical practice, this can occur in cases of: (I) a small left lobe and the need for extended or normal right hepatectomy; (2) major liver surgery in patients with liver function impaired by cirrhosis, severe cholestasis, or primary or postchemotherapeutic secondary fibrosis; and (3) severe fatty steatosis. The fact that PSPVE is well tolerated might expand its indications in the future to increase the safety