Preoperative portal vein embolization is used clinically to prevent postoperative liver insufficiency.
Dr Adel Abulkhir and colleagues performed a meta-analysis to examine the impact of portal vein embolization on liver resection.
The team undertook a Medline search to identify all registered literature in the English language on portal vein embolization.
|88% underwent resection following portal vein embolization|
|Annals of Surgery|
The researchers assessed the result of portal vein embolization, and its impact on major liver resection.
The researchers found that a total of 75 publications met the search criteria but only 37 provided data sufficiently enough for analysis involving 1,088 patients.
The overall morbidity rate for portal vein embolization was 2% without mortality.
Following portal vein embolization for 4 weeks, 85% patients underwent the planned hepatectomy.
The team assessed that 3% of patients had transient liver failure following resection after portal vein embolization.
However, 1% of patients developed acute liver failure and died.
The researchers found that the reason for nonresection following portal vein embolization included inadequate hypertrophy of remnant liver, severe progression of liver metastasis.
Other reasons for nonresection following portal vein embolization included extrahepatic spread, refusal to surgery, and poor general condition.
Altered treatment to transcatheter artery embolization or chemotherapy were additional reasons for nonresection following portal vein embolization.
Complete remission after treatment with 3 cycles of fluoracil and interferon in a patient with hepatocellular carcinoma was another reason for nonresection after embolization.
The researchers found that of those who underwent laparotomy without resection, reasons for embolization included intraoperative finding of peritoneal dissemination.
Portal node metastasis, severe invasion of the tumor to the hepatic artery and portal vein, and gross tumoral extension precluding curative resection were reasons for embolization in these patients.
The team used 2 techniques for portal vein embolization: percutaneous transhepatic portal embolization, and transileocolic portal embolization.
The team of researchers assessed that the increase in remnant liver volume was much greater in percutaneous transhepatic portal embolization than transileocolic portal embolization group.
The proportion of patients who underwent resection following portal vein embolization was 97% with transileocolic portal embolization.
The team noted that 88% underwent resection following portal vein embolization.
There was no significant difference in patients who had major complications post-portal vein embolization.
However, the rate for minor complications was significantly higher among patients who had percutaneous transhepatic portal embolization.
Dr Abulkhir's team concluded, "Portal vein embolization is a safe and effective procedure in inducing liver hypertrophy to prevent postresection liver failure due to insufficient liver remnant."