title: Preoperative portal vein embolization in liver cancer: indications, techniques and outcomes.
abstract: Postoperative liver failure is a severe complication of major hepatectomies, in particular in patients with a chronic underlying liver disease. Portal vein embolization (PVE) is an approach that is gaining increasing acceptance in the preoperative treatment of selected patients prior to major hepatic resection. Induction of selective hypertrophy of the non-diseased portion of the liver with PVE in patients with either primary or secondary hepatobiliary, malignancy with small estimated future liver remnants (FLR) may result in fewer complications and shorter hospital stays following resection. Additionally, PVE performed in patients initially considered unsuitable for resection due to lack of sufficient remaining normal parenchyma may add to the pool of candidates for surgical treatment. A thorough knowledge of hepatic segmentation and portal venous anatomy is essential before performing PVE. In addition, the indications and contraindications for PVE, the methods for assessing hepatic lobar hypertrophy, the means of determining optimal timing of resection, and the possible complications of PVE need to be fully understood before undertaking the procedure. Technique may vary among operators, but cyanoacrylate glue seems to be the best embolic agent with the highest expected rate of liver regeneration for PVE. The procedure is usually indicated when the remnant liver accounts for less than 25-40% of the total liver volume. Compensatory hypertrophy of the non-embolized segments is maximal during the first 2 weeks and persists, although to a lesser extent during approximately 6 weeks. Liver resection is performed 2 to 6 weeks after embolization. The goal of this article is to discuss the rationale, indications, techniques and outcomes of PVE before major hepatectomy.
authors.affiliation: Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François-Mitterrand Teaching Hospital, Dijon Cedex, France.
authors.forename: Romaric
authors.initials: R
authors.lastname: Loffroy
authors.affiliation: Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François-Mitterrand Teaching Hospital, Dijon Cedex, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Favelier
authors.affiliation: Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François-Mitterrand Teaching Hospital, Dijon Cedex, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chevallier
authors.affiliation: Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François-Mitterrand Teaching Hospital, Dijon Cedex, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Estivalet
authors.affiliation: Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François-Mitterrand Teaching Hospital, Dijon Cedex, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Genson
authors.affiliation: Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François-Mitterrand Teaching Hospital, Dijon Cedex, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pottecher
authors.affiliation: Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François-Mitterrand Teaching Hospital, Dijon Cedex, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Gehin
authors.affiliation: Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François-Mitterrand Teaching Hospital, Dijon Cedex, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Krausé
authors.affiliation: Department of Vascular, Oncologic and Interventional Radiology, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, François-Mitterrand Teaching Hospital, Dijon Cedex, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cercueil
keywords: Portal vein embolization (PVE); cyanoacrylate; liver anatomy; liver cancer; surgery