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Venous Embolization of the Liver pp 293–305Cite as

Portal Vein Embolization Prior to Major Hepatectomy: The Evidence

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Abstract

Portal vein embolization (PVE) is increasingly used to increase the volume and function of the liver that will remain after resection of large and multiple liver tumors. This chapter examines the strong, extensive evidence supporting the use of ­preoperative PVE prior to major hepatic resection based on analysis of the future liver remnant (FLR), or liver that will remain after resection. Specifically, data ­demonstrate that liver function is linked both to FLR volume and to the quality of the underlying liver (from normal to diseased to cirrhotic liver along a continuum). The safe limits of resection are defined based on these factors derived from objective studies which reveal the safe limits of resection and the indications for preoperative PVE. Adequate FLR volume in patients with normal liver has been determined to be 20% of the standardized total liver volume, or TLV; in patients with diseased liver, 30% of the TLV; and in patients with (well compensated) cirrhosis, 40% of the TLV. Important evidence demonstrates that PVE can be used to convert a patient with an inadequate FLR to a patient with an FLR sufficient to ensure safe surgery and ­adequate post-resection liver function, and demonstrates that the hypertrophic response or degree of hypertrophy of the FLR after PVE predicts post-resection liver function. Finally, evidence suggests that a ­prospective, randomized trial to test the utility of PVE is neither feasible nor ­necessary based on currently available data.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 444, Houston, TX, USA

    Eddie K. Abdalla

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  1. Eddie K. Abdalla
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Correspondence to Eddie K. Abdalla .

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Editors and Affiliations

  1. New York-Presbyterian Hospital, New York, 10032, New York, USA

    David C. Madoff

  2. University of Tokyo, Hongo 7-3-1, Tokyo, 113-8656, Japan

    Masatoshi Makuuchi

  3. School of Medicine, Dept. Surgery I, Nagoya University, Tsurumai-cho 65, Nagoya, Aichi-ken, 466-8550, Japan

    Masato Nagino

  4. M.D. Anderson Cancer Center, Dept. Surgical Oncology, University of Texas, Holcombe Blvd. 1515, Houston, 77030, Texas, USA

    Jean-Nicolas Vauthey

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Abdalla, E.K. (2011). Portal Vein Embolization Prior to Major Hepatectomy: The Evidence. In: Madoff, D., Makuuchi, M., Nagino, M., Vauthey, JN. (eds) Venous Embolization of the Liver. Springer, London. https://doi.org/10.1007/978-1-84882-122-4_30

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  • DOI: https://doi.org/10.1007/978-1-84882-122-4_30

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