To evaluate the efficacy, safety, and future directions of portal vein embolization (PVE) and simultaneous portal and hepatic vein embolization (PVE/HVE) for increasing future liver remnant (FLR) volume before hepatic resection in patients with colorectal liver metastases.
Key Findings:
PVE is a widely accepted method to induce hypertrophy of the FLR but may be insufficient in some patients, with studies showing a failure rate of 30-40%.
PVE/HVE has emerged as a promising technique to accelerate FLR hypertrophy by occluding both portal and hepatic veins, with preliminary data suggesting improved outcomes.
Studies show that PVE can significantly increase FLR volume, with reported increases of 12% to 11% in various studies, reducing postoperative complications and liver failure.
Interpretation:
PVE and PVE/HVE are critical strategies for enhancing liver volume, improving surgical outcomes, and reducing the risk of postoperative liver failure in patients undergoing major hepatectomy, highlighting the need for further research.
Limitations:
PVE may not achieve sufficient FLR growth in 30-40% of patients with colorectal liver metastases, indicating a need for alternative strategies.
Robust prospective data on PVE/HVE are still emerging, necessitating caution in widespread adoption.
Conclusion:
PVE and PVE/HVE are essential preoperative strategies that enhance liver volume, thereby improving the feasibility and safety of major liver resections, underscoring the importance of ongoing research in this field.
