Preoperative Portal Vein Embolization for Hepatocellular Carcinoma: Consensus and Controversy
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Thirty years have passed since the first report of portal vein embolization (PVE), and this procedure is widely adopted as a preoperative treatment procedure for patients with a small future liver remnant (FLR). PVE has been shown to be useful in patients with hepatocellular carcinoma (HCC) and chronic liver disease. However, special caution is needed when PVE is applied prior to subsequent major hepatic resection in cases with cirrhotic livers, and volumetric analysis of the liver segments in addition to evaluation of the liver functional reserve before PVE is mandatory in such cases. Advances in the embolic material and selection of the treatment approach, and combined use of PVE and transcatheter arterial embolization/chemoembolization have yielded improved outcomes after PVE and major hepatic resections. A novel procedure termed the associating liver partition and portal vein ligation for staged hepatectomy has been gaining attention because of the rapid hypertrophy of the FLR observed in patients undergoing this procedure, however, application of this technique in HCC patients requires special caution, as it has been shown to be associated with a high morbidity and mortality even in cases with essentially healthy livers.
Al Taweel B, Cassese G, Khayat S, Chazal M, Navarro F, Guiu B Cancers (Basel). 2024; 16(11).
PMID: 38893103 PMC: 11171007. DOI: 10.3390/cancers16111982.
Cassese G, Troisi R, Khayat S, Benoudifa B, Quenet F, Guiu B J Gastrointest Surg. 2022; 27(2):296-305.
PMID: 36509901 PMC: 9744374. DOI: 10.1007/s11605-022-05551-2.
Theysohn J, Demircioglu A, Kleditzsch M, Ludwig J, Weber M, Umutlu L Sci Rep. 2022; 12(1):20718.
PMID: 36456637 PMC: 9715713. DOI: 10.1038/s41598-022-25077-6.
Neoadjuvant treatment strategies for hepatocellular carcinoma.
Xu L, Chen L, Zhang W World J Gastrointest Surg. 2022; 13(12):1550-1566.
PMID: 35070063 PMC: 8727178. DOI: 10.4240/wjgs.v13.i12.1550.
Oncological benefits of portal vein embolization for patients with hepatocellular carcinoma.
Beppu T, Yamamura K, Okabe H, Imai K, Hayashi H Ann Gastroenterol Surg. 2021; 5(3):287-295.
PMID: 34095718 PMC: 8164464. DOI: 10.1002/ags3.12414.