The role of portal vein embolization in the surgical management of primary hepatobiliary cancers. A systematic review.
BACKGROUND
Primary liver and biliary cancers are very aggressive tumors. Surgical treatment is the main option for cure or long term survival. The main purpose of this systematic review is to underline the indications for portal vein embolization (PVE), in patients with inadequate future liver remnant (FLR) and to analyze other parameters such as resection rate, morbidity, mortality, survival after PVE and hepatectomy for primary hepatobiliary tumors. Also the role of trans-arterial chemoembolization (TACE) before PVE, is investigated.


METHODS
A systematic search of the literature was performed in Pub Med and the Cochrane Library from 01.01.1990 to 30.09.2015.


RESULTS
Forty articles were selected, including 2144 patients with a median age of 61 years. The median excision rate was 90% for hepatocellular carcinomas (HCCs) and 86% for hilar cholangiocarcinomas (HCs). The main indications for PVE in patients with HCC and presence of liver fibrosis or cirrhosis was FLR <40% when liver function was good (ICGR15 < 10%) and FLR < 50% when liver function was affected (ICGR15:10-20%). The combination of TACE and PVE increased hypertrophy rate and was associated with better overall survival and disease free survival and should be considered in advanced HCC tumors with inadequate FLR. In patients with HCs PVE was performed, after preoperative biliary drainage, when FLR was <40%, in the majority of studies, with very good post-operative outcome. However indications should be refined.


CONCLUSIONS
PVE before major hepatectomy allows resection in a patient group with advanced primary hepato-biliary tumors and inadequate FLR, with good long term survival.
Department of Surgery, School of Medicine, University of Ioannina, Ioannina, Greece. Electronic address: gglantzounis@uoi.gr.
G K
GK
Glantzounis
Department of Surgery, School of Medicine, University of Ioannina, Ioannina, Greece.
E
E
Tokidis
Department of Surgery, School of Medicine, University of Ioannina, Ioannina, Greece.
S-P
SP
Basourakos
Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece.
E E
EE
Ntzani
Department of Surgery, School of Medicine, University of Ioannina, Ioannina, Greece.
G D
GD
Lianos
Department of Medical Oncology, School of Medicine, University of Ioannina, Ioannina, Greece.
G
G
Pentheroudakis
D001650:Bile Duct Neoplasms / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D018281:Cholangiocarcinoma / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D006498:Hepatectomy; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000628:therapy*; D011169:Portal Vein
Biliary cancer; Hepatectomy; Hepatocellular carcinoma (HCC); Hilar cholangiocarcinoma (HC); Intrahepatic cholangiocarcinoma (IHC); Liver resection; Portal vein embolization (PVE); Primary liver cancer