Preoperative Left Portal Vein Embolization for Left Liver Resection in High-Risk Hepatobiliary Malignancy Patients.

Abstract

Preoperative portal vein embolization (PVE) is performed for right liver (RL) and sometimes left liver (LL) resection to prevent postoperative surgical complications. We retrospectively reviewed 10 patients who underwent preoperative left PVE before LL resection for hepatobiliary malignancies along with 3 propensity score-matched control groups (n=40 each). Mean patient age was 68.6±6.9years. Diagnoses included intrahepatic cholangiocarcinoma (n=4), perihilar cholangiocarcinoma (n=3), neuroendocrine carcinoma (n=1), recurrent cholangiocarcinoma (n=1), and inflammatory liver mass (n=1). The reason for left PVE was a large LL>40% of the total liver volume (TLV) with a major comorbidity or age>70years with a poor overall condition. All patients underwent preplanned operations, including LL resection at 1-3weeks post PVE. The LL volume proportion of the TLV was 44.9±1.7 and 40.7±2.3% before and after PVE; thus, 1-2weeks post PVE, the kinetic shrinkage rate of the LL was 9.4±3.3%, and the kinetic growth rate of the RL was 7.6±2.7%. The overall surgical complication rates were 40, 50, and 39.2% in the left PVE, large LL control, and all three control groups, respectively (p≥0.727). In contrast, the adjusted rates of major complications were 0% in the left PVE group versus 36.8% (p=0.040), 25.6% (p=0.123), and 15.8% (p=0.295) in the large-, medium-, and small-sized LL control groups, respectively. Our experience indicates that left PVE is safe and induces atrophy of the LL effectively. We suggest that it can be a useful option to reduce the risk of postoperative complications in elderly high-risk patients.