title: Safety and efficacy of portal vein embolization before planned major or extended hepatectomy: an institutional experience of 358 patients.
abstract: BACKGROUND
  Portal vein embolization (PVE) stimulates hypertrophy of the future liver remnant (FLR) and may improve the safety of extended hepatectomy. The efficacy of PVE was evaluated.
  
  
  METHODS
  Records of 358 consecutive patients who underwent PVE before intended major hepatectomy at our institution from 1995 through 2012 were retrospectively reviewed.
  
  
  RESULTS
  One hundred twelve patients (31.3 %) had right PVE alone; 235 (65.6 %) had right PVE plus segment IV embolization. The first-session PVE completion rate was 97.8 %. The PVE complication rate was 3.9 %. The median pre-PVE and post-PVE standardized FLRs were 19.5 % (interquartile range, 15.0-25.9) and 29.7 % (interquartile range, 22.5-38.2), respectively. Two hundred forty patients (67.0 %) underwent potentially curative resection. Sixty-two patients (25.8 %) had major post-hepatectomy complications; rates of postoperative hepatic insufficiency and 90-day liver-related mortality were 8.3 and 3.8 %, respectively. The proportion of patients with colorectal liver metastasis increased from 38.6 % before 2005 to 78.2 % in 2010-2012. Despite increased use of preoperative chemotherapy, postoperative hepatic insufficiency and 90-day liver-related mortality rates dropped from 10.6 and 4.1 %, respectively, before 2010 to 2.9 and 2.9 %, respectively, in 2010-2012.
  
  
  CONCLUSIONS
  PVE can be safely performed with minimal morbidity. Most patients can proceed to extended hepatectomy, which is associated with a minimal mortality rate.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcomb Boulevard, Unit 1484, Houston, TX, 77030, USA.
authors.forename: Junichi
authors.initials: J
authors.lastname: Shindoh
authors.forename: Ching-Wei D
authors.initials: CW
authors.lastname: Tzeng
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Huang
authors.forename: Armeen
authors.initials: A
authors.lastname: Mahvash
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallace
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy; D006801:Humans; D006984:Hypertrophy / Q000209:etiology; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011169:Portal Vein; D012189:Retrospective Studies; D055815:Young Adult