Portal Vein Embolization in Liver Resection Outcomes

Portal vein embolization (PVE) has become integral to preoperative preparation for major hepatic resection by redirecting portal blood flow to the future liver remnant (FLR). By selectively occluding branches of the portal vein that supply the liver portion to be resected, PVE induces hypertrophy of the non-embolized segments over a period of weeks. This controlled atrophy–hypertrophy complex both increases the volume and often the function of the FLR, reducing the risk of post-hepatectomy liver failure. Clinical success rates routinely exceed 90 per cent, and PVE has been applied worldwide in solid tumour surgery, including colorectal metastases, cholangiocarcinoma and hepatocellular carcinoma.

Mechanistic studies have shown that regional portal deprivation triggers a cascade of growth factors, cytokines and shear-stress responses that enhance compensatory regeneration. Advances in imaging—particularly volumetric CT and functional scintigraphy—now enable precise assessment of FLR to guide timing of surgery. Variations on standard PVE, such as simultaneous hepatic vein embolization or two-stage hepatectomy protocols, aim to accelerate and maximise hypertrophy, while deep-learning tools are emerging to automate vascular segmentation and volumetric prediction. Key challenges remain in optimising embolic materials, integrating systemic therapy without compromising hypertrophy and mitigating tumour progression during the waiting interval. Ongoing trials are comparing novel vein-occlusion strategies to refine the balance between resectability and perioperative safety.

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Portal Vein Embolization in Liver Resection Outcomes publication trend

The graph below shows the total number of articles in portal vein embolization in liver resection outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Portal vein embolization (PVE): A radiological procedure to occlude portal vein branches feeding liver segments planned for resection, redirecting blood flow to induce hypertrophy of the remaining liver.

Future liver remnant (FLR): The proportion of liver volume and function that remains after planned hepatectomy, critical for preventing post-hepatectomy liver failure.

Liver venous deprivation (LVD): A combined embolization technique involving simultaneous occlusion of portal and hepatic veins to accelerate and augment FLR hypertrophy.

Post-hepatectomy liver failure (PHLF): A clinical syndrome characterised by impaired synthetic and excretory liver function after major resection, often linked to insufficient FLR volume or function.

References

1. Fully automated assessment of the future liver remnant in a blood-free setting via CT before major hepatectomy via deep learning. Insights into Imaging (2024).
2. Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy?. Cancers (2023).
3. Extended Right Hepatectomy following Clearance of the Left Liver Lobe and Portal Vein Embolization for Curatively Intended Treatment of Extensive Bilobar Colorectal Liver Metastases: A Single-Center Case Series. Current Oncology (2024).
4. Liver Venous Deprivation (LVD) Versus Portal Vein Embolization (PVE) Alone Prior to Extended Hepatectomy: A Matched Pair Analysis. CardioVascular and Interventional Radiology (2022).
5. Simultaneous portal and hepatic vein embolization before major liver resection. Langenbeck's Archives of Surgery (2020).
6. Study protocol of the HYPER-LIV01 trial: a multicenter phase II, prospective and randomized study comparing simultaneous portal and hepatic vein embolization to portal vein embolization for hypertrophy of the future liver remnant before major hepatectomy for colo-rectal liver metastases. BMC Cancer (2020).
7. Portal Vein Embolization Before Liver Resection: A Systematic Review. CardioVascular and Interventional Radiology (2012).
8. Preoperative Portal Vein Embolization in Hepatic Surgery: A Review about the Embolic Materials and Their Effects on Liver Regeneration and Outcome. Radiology Research and Practice (2020).