Abstract:
Background. Portal vein embolization (PVE) may be used prior to major hepatectomy for hepatocellular carcinoma (HCC) to increase the future liver remnant (FLR) volume. This may also increase tumour growth rate, leading to disease progression or mandate more extensive resection. The aim of this study was to determine the effect of PVE on the surgical plan. Method. A retrospective cohort study was conducted on patients with Child-Pugh A cirrhosis and HCC, who received PVE prior to planned major hepatectomy from 2008-2015. Non-tumour and tumour volumes were calculated on pre- and post-PVE CT scans. Planned and actual procedures performed were compared. Outcomes included overall and progression free survival. Results. Thirty-three patients received PVE. Total non-tumour volume decreased (median 1440 to 1394 cc; p=0.031), while tumour (median 161 to 240 cc; p<0.001) and FLR volumes (median 430 to 574 cc; p<0.001) increased. Pre-PVE surgical plan and actual procedure performed changed in 17/33 patients: no liver resection (n=8), more extensive resection (n=6), less extensive resection (n=1), additional liver directed therapy (n=2). One- and five-year overall survival post-PVE was 71.9% and 56.2% respectively. Median progression free survival was 19.1 months. Conclusion. After PVE prior to planned major hepatectomy for HCC, there is a change in plan for approximately half of patients, who do not undergo a liver resection (24%), undergo a more extensive resection (18%), or require additional liver directed therapy (6%). Therefore, bridging liver directed therapy before PVE needs further investigation to account for this.