title: Preoperative portal vein embolization and surgical resection in patients with hepatocellular carcinoma and small future liver remnant volume: comparison with transarterial chemoembolization.
abstract: BACKGROUND
  Preoperative portal vein embolization (PVE) increases the future liver remnant (FLR) volume, thus enabling surgical resection in patients with small FLR volume. It is unclear, however, if this approach can enhance survival in patients with hepatocellular carcinoma (HCC). We therefore compared the outcomes of preoperative PVE and surgical resection with transarterial chemoembolization (TACE).
  
  
  METHODS
  Changes in FLR volumes were analyzed in 32 HCC patients who underwent preoperative PVE and surgical resection. Long-term outcomes were compared with 64 TACE-treated patients matched for gender, Child-Turcotte-Pugh class, tumor size and number, serum alpha-fetoprotein levels, and UICC stage.
  
  
  RESULTS
  In the PVE group, the baseline ratio of FLR/total estimated liver volumes (TELV) was 27.6 +/- 7.2%. Following PVE, FLR volume increased 34% (336.5 vs 449.4 mL, P < .001) and the ratio of FLR/TELV increased from 27.6 +/- 7.2 to 36.9 +/- 8.1% (P < .001). There was no mortality associated with PVE or surgical resection. The 5-year survival rate was significantly higher in the PVE group than in the TACE group (71.9% vs 45.6%, P = .03). Multivariate analysis showed that treatment modality was an independent predictive factor for survival (odds ratio 2.05, 95% confidence interval 1.01-4.16, P = .046).
  
  
  CONCLUSIONS
  Preoperative PVE enables surgical resection in HCC patients with small FLR volume and improves patient survival compared with TACE.
authors: Department of Internal Medicine, University of Inje College of Medicine, Sanggye Paik Hospital, Seoul, Korea.
authors: Dong Dae
authors: DD
authors: Seo
authors: Han Chu
authors: HC
authors: Lee
authors: Myoung Kuk
authors: MK
authors: Jang
authors: Hyun Ju
authors: HJ
authors: Min
authors: Kang Mo
authors: KM
authors: Kim
authors: Young Suk
authors: YS
authors: Lim
authors: Young-Hwa
authors: YH
authors: Chung
authors: Yung Sang
authors: YS
authors: Lee
authors: Dong Jin
authors: DJ
authors: Suh
authors: Gi-Young
authors: GY
authors: Ko
authors: Young-Joo
authors: YJ
authors: Lee
authors: Sung-Gyu
authors: SG
authors: Lee
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000502:physiology*; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome