Controversies in the use of portal vein embolization.
OBJECTIVE
Portal vein embolization (PVE) has reached worldwide acceptance to increase future remnant liver (FRL) volume before undertaking major liver resection. The aim of this overview is to point out and discuss current controversies in the application of PVE.


METHODS
Review of literature pertaining to techniques of PVE, complications, tumor proliferation, timing of resection, and hypertrophy response after PVE.


RESULTS
Procedure-related complications after PVE include hematoma, hemobilia, overflow of embolization material, and thrombosis of portal vein branch(es) of the non-embolized lobe. Persistence of the embolized, atrophic lobe is usually not harmful. Embolization of the portal branches to segment 4 in addition to embolization of the right portal trunk is controversial and is advised only in selected cases. It remains undecided whether embolization of the portal venous system is more effective in inducing hypertrophy of the FRL than ligation of the portal vein. Accelerated tumor growth after PVE is a major concern and requires consideration of post-PVE chemotherapy. A waiting time of 3 weeks between PVE and liver resection is advised. Post-hepatectomy regeneration is not hampered after preoperative PVE.


CONCLUSIONS
PVE is a useful preoperative intervention to increase volume and function of the FRL. Further progress awaits clarification of the mechanisms of the hypertrophy response induced by PVE in conjunction with new embolization materials and protective chemotherapy.
van Gulik
Thomas M
TM
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. t.m.vangulik@amc.uva.nl
van den Esschert
Jacomina W
JW
de Graaf
Wilmar
W
van Lienden
Krijn P
KP
Busch
Olivier R C
OR
Heger
Michal
M
van Delden
Otto M
OM
Laméris
Johan S
JS
Gouma
Dirk J
DJ
D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D008115:Liver Regeneration / Q000502:physiology*; D008297:Male; D009367:Neoplasm Staging; D010690:Phlebography; D011169:Portal Vein; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome