Published online Nov 15, 2022. doi: 10.4251/wjgo.v14.i11.2088
Peer-review started: August 4, 2022
First decision: September 30, 2022
Revised: October 1, 2022
Accepted: October 31, 2022
Article in press: October 31, 2022
Published online: November 15, 2022
Processing time: 103 Days and 6.9 Hours
Portal vein embolization (PVE) is currently considered the standard of care to improve the volume of an inadequate future remnant liver (FRL) and decrease the risk of post-hepatectomy liver failure (PHLF). PHLF remains a significant limitation in performing major liver surgery and is the main cause of mortality after resection. The degree of hypertrophy obtained after PVE is variable and depends on multiple factors. Up to 20% of patients fail to undergo the planned surgery because of either an inadequate FRL growth or tumor progression after the PVE procedure (usually 6-8 wk are needed before surgery). The management of PVE failure is still debated, with a lack of consensus regarding the best clinical strategy. Different additional techniques have been proposed, such as sequential transarterial chemoembolization followed by PVE, segment 4 PVE, intra-portal administration of stem cells, dietary supplementation, and hepatic vein emb
Core Tip: Portal vein embolization (PVE) is actually considered the standard of care for inducing volume augmentation of the future remnant liver. However, 20% of patients who have undergone PVE, reportedly never undergo curative resection, due to either insufficient future remnant liver (FRL) growth with an unacceptable risk of post-hepatectomy liver failure, or oncologic progression after PVE, while waiting for the adequate FRL hypertrophy (6-8 wk or more). The management of PVE failure is still highly debated, with different additional techniques that have been proposed, such as sequential transarterial chemoembolization followed by PVE, segment 4 PVE, intra-portal administration of stem cells, dietary supplementation, and hepatic vein embolization.