Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization

Abstract

Hypothesis Preoperative portal vein embolization (PVE) allows potentially curative hepatic resection without additional morbidity or mortality in patients with hepatobiliary malignancies who are marginal candidates for resection based on small liver remnant size.

Design A retrospective review of a consecutive series of patients in a multi-institutional database who underwent extended hepatectomy.

Setting University-based referral centers.

Patients Forty-two patients underwent preoperative determination of the future liver remnant (FLR) volume before extended hepatectomy (≥5 segments) for hepatobiliary malignancy without chronic underlying liver disease. Patients were stratified by treatment with or without preoperative PVE.

Intervention Preoperative percutaneous PVE.

Main Outcome Measures Clinical characteristics, FLR volume, operative morbidity, and survival.

Results There was no difference between the groups that did and did not undergo PVE for the number of tumors, tumor size, estimated blood loss, duration of the operation, complexity of resection, or surgical margins. The FLR at presentation was significantly smaller in patients who underwent PVE than in patients who did not undergo PVE (18% vs 23%; P<.001). After PVE, FLR volumes increased significantly (P = .003); preoperative FLR volumes were similar in both groups (patients who underwent PVE, 25%; and patients who did not undergo PVE, 23%). There was no perioperative mortality and no statistical difference in the incidence of perioperative complications between those who did and those who did not undergo PVE (5 [28%] of 18 patients vs 5 [21%] of 24 patients). The overall 3-year survival was 65% and the median survival duration was equivalent in the 2 groups (40 vs 52 months for those who did vs those who did not undergo PVE).

Conclusion Portal vein embolization enables safe and potentially curative extended hepatectomy in a subset of patients who would otherwise be marginal candidates for resection based on a small liver remnant size.