Efficacy of Pre-Operative Portal Vein Embolization of Biliary Neoplasm before Major Hepatectomy

Abstract

Background: Malignant biliary neoplasm is relatively common in Southeast Asia. Portal vein embolization (PVE) is a preoperative procedure to induce hypertrophy of future liver remnants. PVE can decrease the rate of post hepatectomy liver failure (PHLF). Objective: To evaluate the efficacy of preoperative PVE of biliary neoplasm patient prior to major hepatic resection. Materials and Methods: The study included 53 patients with biliary neoplasm planned for major hepatic resection and that underwent PVE between July 2013 and August 2019. Liver volumetry before and after PVE was analyzed. Operative procedure and post hepatectomy outcome were evaluated. Results: Peri-hilar type cholangiocarcinoma, Bismuth-Corlette classification IIIA was the most frequent tumor. The technical success rate of PVE is 100%. Future liver remnant (FLR) volume after PVE was significantly increased from 379.1 to 460 mL (p<0.001). Post PVE FLR over total functional liver volume (TFLV) ratio was significantly increased from 27.8% to 34.6%(p<0.001). The mean kinetic growth rate (KGR) per week was 7.1%. Twenty-four patients underwent subsequent hepatectomy, and two patients presented with PHLF. Twenty-nine patients (54.7%) did not undergo subsequent hepatectomy as planned due to advanced disease with 21 (72.4%) because of locally advanced cancer, peritoneal carcinomatosis, and N2 lymph nodes metastasis), four (13.8%) that refused surgical treatment, and three (10.3%) that were loss to follow-up. Conclusion: Preoperative PVE before major hepatic resection in biliary neoplasm patients is an effective procedure to increase FLR, FLR/TFLV ratio, and provide good KGR. However, more than half of post preoperative PVE could not be obtained hepatectomy because of the progression to advanced stage of disease. Keywords: Biliary neoplasm, Portal vein embolization, Future liver remnant, Major hepatic resection, Post hepatectomy liver failure