Cassese G, Han HS, Lee B, Cho JY, Lee HW, Guiu B, Panaro F, Troisi RI. Portal vein embolization failure: Current strategies and future perspectives to improve liver hypertrophy before major oncological liver resection. World J Gastrointest Oncol 2022; 14(11): 2088-2096 [PMID: 36438704 DOI: 10.4251/wjgo.v14.i11.2088]
Corresponding Author of This Article
Ho-Seong Han, MD, PhD, Professor, Department of Surgery, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Seongnam 13620, South Korea. hanhs@snubh.org
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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/
World J Gastrointest Oncol. Nov 15, 2022; 14(11): 2088-2096 Published online Nov 15, 2022. doi: 10.4251/wjgo.v14.i11.2088
Portal vein embolization failure: Current strategies and future perspectives to improve liver hypertrophy before major oncological liver resection
Gianluca Cassese, Ho-Seong Han, Boram Lee, Jai Young Cho, Hae Won Lee, Boris Guiu, Fabrizio Panaro, Roberto Ivan Troisi
Gianluca Cassese, Roberto Ivan Troisi, Clinical Medicine and Surgery, Federico II University, Naples 80131, Italy
Ho-Seong Han, Jai Young Cho, Department of Surgery, Seoul National University College of Medicine, Seongnam 13620, South Korea
Boram Lee, Hae Won Lee, Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, South Korea
Boris Guiu, Department of Medical Imaging and Interventional Radiology, St-Eloi University Hospital, Montpellier 34295, France
Fabrizio Panaro, Digestive Surgery and Transplantation, CHU de Montpellier, Montpellier 34295, France
Author contributions: Cassese G, Han HS, Panaro F, and Troisi RI conceived and designed the study; Lee HW, Cho JY, Guiu B, and Troisi RI critically revised the manuscript; Cassese G and Lee B wrote the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ho-Seong Han, MD, PhD, Professor, Department of Surgery, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Seongnam 13620, South Korea. hanhs@snubh.org
Received: August 4, 2022 Peer-review started: August 4, 2022 First decision: September 30, 2022 Revised: October 1, 2022 Accepted: October 31, 2022 Article in press: October 31, 2022 Published online: November 15, 2022 Processing time: 103 Days and 6.9 Hours
Abstract
Portal vein embolization (PVE) is currently considered the standard of care to improve the volume of an inadequate future remnant liver (FRL) and decrease the risk of post-hepatectomy liver failure (PHLF). PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after resection. The degree of hypertrophy obtained after PVE is variable and depends on multiple factors. Up to 20% of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure (usually 6-8 wk are needed before surgery). The management of PVE failure is still debated, with a lack of consensus regarding the best clinical strategy. Different additional techniques have been proposed, such as sequential transarterial chemoembolization followed by PVE, segment 4 PVE, intra-portal administration of stem cells, dietary supplementation, and hepatic vein embolization. The aim of this review is to summarize the up-to-date strategies to overcome such difficult situations and discuss future perspectives on improving FRL hypertrophy.
Core Tip: Portal vein embolization (PVE) is actually considered the standard of care for inducing volume augmentation of the future remnant liver. However, 20% of patients who have undergone PVE, reportedly never undergo curative resection, due to either insufficient future remnant liver (FRL) growth with an unacceptable risk of post-hepatectomy liver failure, or oncologic progression after PVE, while waiting for the adequate FRL hypertrophy (6-8 wk or more). The management of PVE failure is still highly debated, with different additional techniques that have been proposed, such as sequential transarterial chemoembolization followed by PVE, segment 4 PVE, intra-portal administration of stem cells, dietary supplementation, and hepatic vein embolization.
