title: Role of portal vein embolization in hepatocellular carcinoma management and its effect on recurrence: a case-control study.
abstract: BACKGROUND
  Liver regeneration that occurs after portal vein embolization (PVE) may have adverse effects on the microscopic tumor foci in the residual liver mass in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  Fifty-four HCC patients with inadequate functional residual liver volume were offered PVE during a seven-year period. Among them, 34 (63%) patients underwent curative resection. They were compared with a matched control group (n = 102) who underwent surgery without PVE. Postoperative complications, pattern of recurrence, and survival were compared between groups.
  
  
  RESULTS
  In the PVE group, a pre-embolization functional residual liver volume of 23% (12-33.5%) improved to 34% (20-54%) (p = 0.005) at the time of surgery. When the two groups were compared, minor (PVE, 24%; control, 29%; p = 0.651) and major (PVE, 18%; control, 15%; p = 0.784) complications were similar. After a follow-up period of 35 months (standard deviation 25 months), extrahepatic recurrences were detected in 10 PVE patients (29%) and 41 control patients (40%) (p = 0.310). Intrahepatic recurrences were seen in 10 (29%) and 47 (46%) cases (p = 0.109) in the PVE and control groups, respectively. In the PVE group, 41% (n = 14) of the recurrences were detected before one year, compared with 42% (n = 43) in the control group (p = 1). Disease-free survival rates at 1, 3, and 5 years were 57, 29, and 26% in the control group and 60, 42, and 42% in the PVE group (log-rank, p = 0.335). On multivariate analysis, PVE was not a factor affecting survival (p = 0.821).
  
  
  CONCLUSIONS
  Portal vein embolization increases the resectability of initially unresectable HCC due to inadequate functional residual liver volume, and it has no deleterious oncological effect after major resection of HCC.
authors.affiliation: Department of Surgery, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, People's Republic of China.
authors.forename: Rohan C
authors.initials: RC
authors.lastname: Siriwardana
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Sheung Tat
authors.initials: ST
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000628:therapy*; D016022:Case-Control Studies; D016461:Chemoembolization, Therapeutic; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011169:Portal Vein; D011300:Preoperative Care