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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 28, 2016; 8(9): 439-445
Published online Mar 28, 2016. doi: 10.4254/wjh.v8.i9.439
Preoperative portal vein embolization for hepatocellular carcinoma: Consensus and controversy
Taku Aoki, Keiichi Kubota
Taku Aoki, Keiichi Kubota, Second Department of Surgery, Dokkyo Medical University, Tochigi 321-0293, Japan
Author contributions: Aoki T and Kubota K analyzed the literature and wrote the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Taku Aoki, MD, PhD, Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan. aoki-2su@dokkyomed.ac.jp
Telephone: +81-282-872158 Fax: +81-282-866317
Received: April 29, 2015
Peer-review started: May 8, 2015
First decision: September 8, 2015
Revised: January 18, 2016
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: March 28, 2016
Processing time: 329 Days and 18.2 Hours
Abstract

Thirty years have passed since the first report of portal vein embolization (PVE), and this procedure is widely adopted as a preoperative treatment procedure for patients with a small future liver remnant (FLR). PVE has been shown to be useful in patients with hepatocellular carcinoma (HCC) and chronic liver disease. However, special caution is needed when PVE is applied prior to subsequent major hepatic resection in cases with cirrhotic livers, and volumetric analysis of the liver segments in addition to evaluation of the liver functional reserve before PVE is mandatory in such cases. Advances in the embolic material and selection of the treatment approach, and combined use of PVE and transcatheter arterial embolization/chemoembolization have yielded improved outcomes after PVE and major hepatic resections. A novel procedure termed the associating liver partition and portal vein ligation for staged hepatectomy has been gaining attention because of the rapid hypertrophy of the FLR observed in patients undergoing this procedure, however, application of this technique in HCC patients requires special caution, as it has been shown to be associated with a high morbidity and mortality even in cases with essentially healthy livers.

Keywords: Hepatocellular carcinoma; Future liver remnant; Poral vein embolization; Liver functional reserve; The associating liver partition and portal vein ligation for staged hepatectomy

Core tip: Preoperative portal vein embolization (PVE) has been developed to secure the safety of a major hepatic resection by inducing the hypertrophy of the future liver remnant. PVE has been shown to be useful for patients with hepatocellular carcinoma and chronic liver disease. However, the indications should be carefully judged based on the volumetric analysis and evaluation of the liver functional reserve. Recently, a novel technique called the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been introduced to gain a rapid hypertrophy of the future liver remnant; however, at present, data supporting ALPPS in hepatocellular carcinoma with cirrhosis are still very weak.