Portal Vein Embolization Before Liver Resection: A Systematic Review

• Published in: Cardiovascular and interventional radiology 2013-02, Vol.36 (1), p.25-34
• Main Authors: van Lienden, K. P., van den Esschert, J. W., de Graaf, W., Bipat, S., Lameris, J. S., van Gulik, T. M., van Delden, O. M.
• Format: Article
• Language: English
• Subjects: Cardiology; CHEMOTHERAPY; COMPARATIVE EVALUATIONS; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; HEAD; Hepatectomy - adverse effects; Hepatectomy - methods; Hepatectomy - mortality; Humans; HYPERTROPHY; Imaging; LIVER; LIVER CIRRHOSIS; Liver Cirrhosis - mortality; Liver Cirrhosis - pathology; Liver Cirrhosis - surgery; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; MORTALITY; Nuclear Medicine; PATIENTS; Portal Vein; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Preoperative Care - methods; Prognosis; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Review /State of the Art; Review Article/State of the Art; REVIEWS; Risk Assessment; SURGERY; Survival Rate; Treatment Outcome; Ultrasound; VEINS
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-012-0440-y

Purpose This is a review of literature on the indications, technique, and outcome of portal vein embolization (PVE). Methods A systematic literature search on outcome of PVE from 1990 to 2011 was performed in Medline, Cochrane, and Embase databases. Results Forty-four articles were selected, including 1,791 patients with a mean age of 61 ± 4.1 years. Overall technical success rate was 99.3 %. The mean hypertrophy rate of the FRL after PVE was 37.9 ± 0.1 %. In 70 patients (3.9 %), surgery was not performed because of failure of PVE (clinical success rate 96.1 %). In 51 patients (2.8 %), the hypertrophy response was insufficient to perform liver resection. In the other 17 cases, 12 did not technically succeed (0.7 %) and 7 caused a complication leading to unresectability (0.4 %). In 6.1 %, resection was cancelled because of local tumor progression after PVE. Major complications were seen in 2.5 %, and the mortality rate was 0.1 %. A head-to-head comparison shows a negative effect of liver cirrhosis on hypertrophy response. The use of n-butyl cyanoacrylate seems to have a greater effect on hypertrophy, but the difference with other embolization materials did not reach statistical significance. No difference in regeneration is seen in patients with cholestasis or chemotherapy. Conclusions Preoperative PVE has a high technical and clinical success rate. Liver cirrhosis has a negative effect on regeneration, but cholestasis and chemotherapy do not seem to have an influence on the hypertrophy response. The use of n-butyl cyanoacrylate may result in a greater hypertrophy response compared with other embolization materials used.