Major hepatic resection for hepatocellular carcinoma with or without portal vein embolization: Perioperative outcome and survival

Background. Preoperative portal vein embolization (PVE) is performed to minimize perioperative risks of major hepatic resection, for hepatocellular carcinoma (HCC), but its effects on tumor growth, are ill defined. Perioperative outcome and survival after major hepatic resection for HCC, with and without, PVE, were investigated. Methods. Patients that underwent major hepatic resection (>= 3 segments) for HCC between, January 1998 and May 2007 were analyzed retrospectively. Preoperative PIE was performed when the remnant liver volume zoos predicted to be insufficient. Results. A total of 54 patients underwent major hepatic resection, for HCC: 21 patients with PVE before resection. (PIE group) and 33 patients without PIE (non-PVE group). PIE and non. PIE groups had, similar rates of fibrosis or cirrhosis, hepatitis C virus, hepatitis B virus, American Joint Committee on Cancer stage, preoperative transarterial chemoembolization, overall postoperative complications, and positive margin (P = nonsignificant for all, rates). There were no perioperative deaths in the PVE,, group and 6 (18%) deaths in the. non-PIE group (P =.038). Median follow-up was 21 months. Excluding perioperative deaths, overall survival rates at 1, 3, and 5 years were 94%, 82%, and 72%, respectively, in the PVE group and 93%, 63%, and 54%, respectively, in the non-PVE group (P = .35). Similarly, disease free survival (DFS) rates were not significantly different between the groups, with 1-, 3-, and 5-year DFS rates of 84%, 56%, and 56%, respectively, in the PVE group and 66%, 49%, and 49%, respectively, in the non-PVE group (P =.38). Conclusion. PIE before major hepatic resection for HCC is associated with improved, perioperative outcome. Excluding perioperative mortality, overall survival anal DFS rates were similar between patients with and without preoperative PIE. (Surgery 2009;145:399-405.)