Portal vein embolization prior to major hepatectomy: A multidisciplinary approach for advanced liver tumors in Chile

• Published in: Revista medíca de Chile 2024-01, Vol.152 (1), p.28
• Main Authors: Riveros, Sergio, Irarrázaval, María Jesús, Peñailillo, Antonio, Hevia, Joaquín, Achurra, Pablo, Briceño, Eduardo, Viñuela, Eduardo, Rebolledo, Patricia, Jarufe, Nicolás, Martínez, Jorge, Meneses, Luis, Dib, Martin
• Format: Article
• Language: Spanish
• Subjects: Aged; Chile; Disease-Free Survival; Embolization, Therapeutic - methods; Female; Hepatectomy - methods; Humans; Liver Neoplasms - surgery; Liver Neoplasms - therapy; Male; Middle Aged; Portal Vein; Preoperative Care - methods; Retrospective Studies; Treatment Outcome
• ISSN: 0717-6163; 0717-6163
• DOI: 10.4067/s0034-98872024000100028

One of the main limitations to achieving a complete tumor resection in patients with technically resectable liver tumors is the presence of a small future liver remnant (FLR). Portal vein embolization (PVE) allows hypertrophy of the non-embolized lobe, reducing the risk of postoperative liver failure. To describe the experience of portal embolization prior to hepatectomy and its effectiveness in converting advanced unresectable liver tumors into resectable tumors. Non-concurrent cohort study. All patients who underwent PVE before hepatectomy between 2016 and 2020 in our center were included. Demographic and diagnostic variables, pre and post-PVE volumes, perioperative variables, and global and disease-free survival were analyzed. Nineteen patients were included. Median age 66 (54-72) years and 57.9% (n= 11) were women. Bilateral metastases were present in 78.9% (n= 15). Sixteen patients (84.2%) received neoadjuvant chemotherapy. One patient (5.3%) had a complication after PVE. The median time between embolization and volumetry was 5.3 weeks (4.7-7.1). Median FLR before and after PVE were 19.8% (16.2-27.7) and 30% (25.2-40.5), respectively. The median percentage of hypertrophy was 48% (40.4-76.5). Fifteen patients (78.9%) underwent hepatectomy. Significant complications occurred in 26.6% (n= 4); among them, three patients (20%) presented postoperative liver failure. PVE is safe and effective in promoting FLR hypertrophy in the presence of chemotherapy, allowing patients with advanced liver tumors to undergo surgery with curative intent.