title: Portal vein embolization with plug/coils improves hepatectomy outcome.
abstract: BACKGROUND
  Portal vein embolization (PVE) has become the standard of care before extended hepatectomy. Various PVE methods using different embolization materials have been described. In this study, we compared PVE with polyvinyl alcohol particles alone (PVA only) versus PVA with plug or coils (PVA + plug/coils).
  
  
  METHODS
  Patients undergoing PVE before hepatectomy were included. PVA alone was used until December 2013, thereafter plug or coils were placed in addition. The volume of left lateral liver lobe (LLL), clinical parameters, and liver function tests were measured before PVE and resection.
  
  
  RESULTS
  A total of 43 patients were recruited into the PVA only group and 42 were recruited into the PVA + plug/coils group. There were no major differences between groups except significantly higher total bilirubin level before PVE in the PVA only group, which improved before hepatectomy. Mean LLL volume increased by 25.7% after PVE in the PVA only group and by 44% in the PVA + plug/coils group (P < 0.001). Recanalization was significantly less common in the PVA + plug/coils group. In multivariate regression, initial LLL volume and use of plug or coils were the only parameters influencing LLL volume increase. The postoperative liver failure rate was significantly reduced in PVA + plug/coils group (P = <0.001).
  
  
  CONCLUSIONS
  PVE using PVA particles together with plug or coils is a safe and efficient method to increase future liver remnant volume. The additional central embolization with plug or coils led to an increased hypertrophy, due to lower recanalization rates, and subsequently decreased incidence of postoperative liver failure. No additional procedure-specific complications were observed in this series.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. Electronic address: maciej.malinowski@charite.de.
authors.forename: Maciej
authors.initials: M
authors.lastname: Malinowski
authors.affiliation: Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Geisel
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Victoria
authors.initials: V
authors.lastname: Stary
authors.affiliation: Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Maximillian
authors.initials: M
authors.lastname: Jara
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Annekathrin
authors.initials: A
authors.lastname: Baron
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.affiliation: Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gebauer
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Stockmann
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D018285:Klatskin Tumor / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Central embolization; Extended hepatectomy; Future liver remnant; LiMAx test; Portal vein embolization