Salvage hepatectomy in failed portal vein embolisation

Abstract

Background: The traditional approach to induce liver hypertrophy of future liver remnant (FLR) is portal vein embolization (PVE). We analyse the cases which failed to achieve sufficient hypertrophy following PVE and has been salvaged by two staged hepatectomy. Methods: Of 72 cases of PVE over 8 years, 4 cases didn't achieve sufficient hypertrophy and subsequently underwent two stage hepatectomy. Patient characteristics, volume increase, postoperative complications and outcomes were analyzed. Results: All 4 patients had extended right hepatectomy. One patient had colorectal liver metastasis and the other three had hilar cholangiocarcinoma. Three patients with hilar cholangiocarcinoma or gall bladder carcinoma had resection of extrahepatic bile ducts and PV resection. The staged resections were carried out at an average of 11 (7–20) days apart. Patient 1 had an FLR of 18%after PVE that increased to 28% after parenchymal transection (stage 1). Patient 2 had an FLR of 20% after PVE which increased to 29% after stage 1 resection. Patient 3 had FLR of 21% after PVE which increased to 34% after stage 1 resection. Patient 4 had FLR volume of 30% with background chronic liver fibrosis that increased to 38% after stage 1. A further 10% (8–13) increase in FLR was achieved following stage 1 resection. Two patients had postoperative bile leak. There was no operative mortality and all patients are alive with a median disease free survival of 20 months. Conclusion: Salvage resection of liver is an effective approach to patients who do not achieve sufficient FLR volume following PVE.