Short-term outcome of portal vein embolization vs. simultaneous portal and hepatic vein embolization for major liver resection – preliminary results?

Abstract

Purpose: In a retrospective analysis we compared the effect and clinical outcome of simultaneous and sequential hepatic vein embolization (HVE) compared to portal vein embolization (PVE). Method: All patients, treated with PVE only or PVE with simultaneous or sequential HVE, prior to the major hepatectomy were included in the analysis. N-butyl-cyanoacrylate was used for PVE via transhepatic /transsplenic access, whereas HVE vascular plugs were applied for HVE via the jugular vein. Future remnant liver volume (FRLV) prior and following interventions was assessed via CT volumetry. Laboratory parameters and clinical courses were obtained from the clinical charts. Results: 16 patients were treated with simultaneous PVE and HVE, whereas the other 16 patients received PVE only and another 4 received sequential PVE and HVE. Left-sided thrombosis was observed in 6 patients after the simultaneous intervention and in 1 patient in the PVE group. Significant hypertrophy was noted in all patients (1.6-fold in the PVE group and 1.5-fold in the simultaneous group). Additional HVE induced a non-significant hypertrophy following PVE. However, only 8 of 16 patients in the simultaneous group, 9 of 16 patients in the PVE only group, and only one patient in the sequential group could undergo resection. The main reason for the drop-off was disease progression (12), impaired liver function (3) and portal venous thrombus (1). Conclusion: PVE and simultaneous PVE/HVE resulted in comparable hypertrophy induction and drop-off rates, however, the simultaneous treatment caused more left-sided portal vein thrombosis, which may jeopardize the surgery. Additional HVE after PVE might be useful for initial insufficient hypertrophy.