Document Detail

Controversies in the use of portal vein embolization.
MedLine Citation:
PMID:  19212116     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/AIMS: Portal vein embolization (PVE) has reached worldwide acceptance to increase future remnant liver (FRL) volume before undertaking major liver resection. The aim of this overview is to point out and discuss current controversies in the application of PVE. METHODS: Review of literature pertaining to techniques of PVE, complications, tumor proliferation, timing of resection, and hypertrophy response after PVE. RESULTS: Procedure-related complications after PVE include hematoma, hemobilia, overflow of embolization material, and thrombosis of portal vein branch(es) of the non-embolized lobe. Persistence of the embolized, atrophic lobe is usually not harmful. Embolization of the portal branches to segment 4 in addition to embolization of the right portal trunk is controversial and is advised only in selected cases. It remains undecided whether embolization of the portal venous system is more effective in inducing hypertrophy of the FRL than ligation of the portal vein. Accelerated tumor growth after PVE is a major concern and requires consideration of post-PVE chemotherapy. A waiting time of 3 weeks between PVE and liver resection is advised. Post-hepatectomy regeneration is not hampered after preoperative PVE. CONCLUSION: PVE is a useful preoperative intervention to increase volume and function of the FRL. Further progress awaits clarification of the mechanisms of the hypertrophy response induced by PVE in conjunction with new embolization materials and protective chemotherapy.
Thomas M van Gulik; Jacomina W van den Esschert; Wilmar de Graaf; Krijn P van Lienden; Olivier R C Busch; Michal Heger; Otto M van Delden; Johan S Laméris; Dirk J Gouma
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-02-12
Journal Detail:
Title:  Digestive surgery     Volume:  25     ISSN:  1421-9883     ISO Abbreviation:  Dig Surg     Publication Date:  2008  
Date Detail:
Created Date:  2009-02-12     Completed Date:  2009-05-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8501808     Medline TA:  Dig Surg     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  436-44     Citation Subset:  IM    
Copyright Information:
(c) 2009 S. Karger AG, Basel.
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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MeSH Terms
Combined Modality Therapy
Embolization, Therapeutic / adverse effects,  methods*
Hepatectomy / methods*
Liver Neoplasms / blood supply,  mortality,  surgery,  therapy*
Liver Regeneration / physiology*
Neoplasm Staging
Portal Vein
Preoperative Care / methods
Risk Assessment
Sensitivity and Specificity
Survival Analysis
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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