Liver related complications in unresectable disease after portal vein embolization.

Background: Portal vein embolization (PVE) is used preoperatively in patients to increase future remnant liver volume (FRLV). Unfortunately, some patients are found to be unresectable at exploration due to tumor progression or new lesions. The aim of this study is to evaluate the long-term effects of PVE in the embolized liver lobe when left unresected.

Methods: Of 85 patients who underwent right PVE, 16 (19%) were unresectable (PVE-group). These patients were compared with 48 randomly matched patients from a pool of 75 unresectable patients who had not undergone PVE. Primary outcome parameter was occurrence of infectious complications (liver abscesses) on follow-up imaging of the liver. The long-term volumetric changes of the hypertrophy/atrophy complex were assessed as secondary outcome parameter.

Results: Five of 16 (31%) patients in PVE-group developed an abscess vs. 4 (8%) patients in non-PVE group (P=0.022). The volume distribution of left and right liver lobes (hypertrophy-atrophy rate) increased from 26%:74% before embolization to 36%:64% three weeks after PVE and to 51%:49% six months after PVE.

Conclusions: Persistence of embolized liver lobe in unresectable patients after PVE resulted in abscesses in 31%. This observation calls for developing reversible embolization techniques using absorbable materials in patients with uncertain resectability.