title: Preoperative Left Portal Vein Embolization for Left Liver Resection in High-Risk Hepatobiliary Malignancy Patients.
abstract: Preoperative portal vein embolization (PVE) is performed for right liver (RL) and sometimes left liver (LL) resection to prevent postoperative surgical complications.
  
  
  
  We retrospectively reviewed 10 patients who underwent preoperative left PVE before LL resection for hepatobiliary malignancies along with 3 propensity score-matched control groups (n = 40 each).
  
  
  
  Mean patient age was 68.6 ± 6.9 years. Diagnoses included intrahepatic cholangiocarcinoma (n = 4), perihilar cholangiocarcinoma (n = 3), neuroendocrine carcinoma (n = 1), recurrent cholangiocarcinoma (n = 1), and inflammatory liver mass (n = 1). The reason for left PVE was a large LL >40 % of the total liver volume (TLV) with a major comorbidity or age > 70 years with a poor overall condition. All patients underwent preplanned operations, including LL resection at 1-3 weeks post PVE. The LL volume proportion of the TLV was 44.9 ± 1.7 and 40.7 ± 2.3 % before and after PVE; thus, 1-2 weeks post PVE, the kinetic shrinkage rate of the LL was 9.4 ± 3.3 %, and the kinetic growth rate of the RL was 7.6 ± 2.7 %. The overall surgical complication rates were 40, 50, and 39.2 % in the left PVE, large LL control, and all three control groups, respectively (p ≥ 0.727). In contrast, the adjusted rates of major complications were 0 % in the left PVE group versus 36.8 % (p = 0.040), 25.6 % (p = 0.123), and 15.8 % (p = 0.295) in the large-, medium-, and small-sized LL control groups, respectively.
  
  
  
  Our experience indicates that left PVE is safe and induces atrophy of the LL effectively. We suggest that it can be a useful option to reduce the risk of postoperative complications in elderly high-risk patients.
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea. shwang@amc.seoul.kr.
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Department of Diagnostic Imaging, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Myeong-Hwan
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sung-Koo
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Diagnostic Imaging, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Gwon
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D018278:Carcinoma, Neuroendocrine / Q000601:surgery; D016022:Case-Control Studies; D018281:Cholangiocarcinoma / Q000601:surgery; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications; D011300:Preoperative Care; D012189:Retrospective Studies