Comparative characteristics of embolization and ligation of the right branch of the portal vein (literature review)

The purpose of the study was to compare the methods of mechanical reduction of blood flow in the right branch of the portal vein: portal vein embolization (PVE) and portal vein ligation (PVL) as a neoadjuvant treatment before extended hepatectomy to induce hypertrophy of the future liver remnant (FLR) for the prevention of post-resection hepatic failure (PRHF). Material and Methods. A total of 28 publications from PubMed and ScienceDirect databases, the International Hepato-Pancreato-Biliary Association, monographs and guidelines for physicians, covering the period from 2001 to 2004, were analyzed. The search for articles in the PubMed database was conducted using the key words: “portal vein embolization” and “portal vein ligation” with the parameters “Free full text”, “Review”, “5 years”. 22 articles were selected as relevant. Conclusion. In general, no clear and unanimous opinion was found among the authors regarding the rate of FLR hypertrophy between the PVE and PVL methods. However, most authors recommended PVL. As for the time interval from PVE/PVL to the second stage of surgery, the opinions were equally bipolar. Many authors recommended additional segment IV embolization to enhance the regenerative potential, which is associated with technical difficulties and requires advanced skills. The problem of post-occlusion tumor progression was widely reported, the highest percentage of cases was described after PVE. This fact is explained by hemodynamic restructuring, stimulation of cytokine and growth factor production. The cases of insufficient FLR hypertrophy due to the development of intrahepatic collaterals, especially after PVL, were described. Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) was proposed as an alternative to prevent this complication. Complications after PVE/PVL were poorly described, with isolated reports of contralateral embolization, intra-abdominal choleraemia or hemorrhage, and distant periportal fibrosis. To date, PVE remains the gold standard as the first stage of two-stage extensive liver resections, as a prevention of post-resection liver failure.

1. Cassese G., Han H.S., Lee B., Cho J.Y., Lee H.W., Guiu B., Panaro F., Troisi R.I. Portal vein embolization failure: Current strategies and future perspectives to improve liver hypertrophy before major oncological liver resection. World J Gastrointest Oncol. 2022; 14(11): 2088–96. doi: 10.4251/wjgo.v14.i11.2088.

2. Yi F., Zhang W., Feng L. Efficacy and safety of different options for liver regeneration of future liver remnant in patients with liver malignancies: a systematic review and network meta-analysis. World J Surg Oncol. 2022; 20(1): 399. doi: 10.1186/s12957-022-02867-w.

3. Chan K.S., Low J.K., Shelat V.G. Associated liver partition and portal vein ligation for staged hepatectomy: a review. Transl Gastroenterol Hepatol. 2020; 5: 37. doi: 10.21037/tgh.2019.12.01.

4. Jin S., Fu Q., Wuyun G., Wuyun T. Management of post-hepatectomy complications. World J Gastroenterol. 2013; 19(44): 7983–91. doi: 10.3748/wjg.v19.i44.7983.

5. Shabunin A.V., Karalkin A.V., Belousova A.P., Kizhaev E.V., Grekov D.N. Prevention and management of postoperative liver failure after extensive liver resections. Annals of Surgery. 2018; 23 (4): 211–18. (in Russia). doi: 10.18821/1560-9502-2018-23-4-211-218. EDN: YOCNTF.

6. Le Roy B., Gallon A., Cauchy F., Pereira B., Gagnière J., Lambert C., Yoh T., Boyer L., Pezet D., Buc E., Chabrot P. Combined biembolization induces higher hypertrophy than portal vein embolization before major liver resection. HPB. 2020; 22(2): 298–305. doi: 10.1016/j.hpb.2019.08.005.

7. de Santibañes E., Clavien P.A. Playing Play-Doh to prevent postoperative liver failure: the “ALPPS” approach. Ann Surg. 2012; 255(3): 415–17. doi: 10.1097/SLA.0b013e318248577d.

8. Rous P., Larimore L.D. Relation of the portal blood to liver maintenance: a demonstration of liver atrophy conditional on compensation. J Exp Med. 1920; 31(5): 609–32. doi: 10.1084/jem.31.5.609.

9. Huisman F., van Lienden K.P., Damude S., Hoekstra L.T., van Gulik T.M. A review of animal models for portal vein embolization. J Surg Res. 2014; 191(1): 179–88. doi: 10.1016/j.jss.2014.05.089.

10. Madoff D.C. Preoperative Portal Vein Embolization: A method to improve the safety of major hepatic resection. Endovascular today. 2005; November. Reprints: 70–80.

11. Liver surgery. Operational techniques and minimally invasive technologies: a guide for physicians. Ed. O.G. Skipenko. Moscow, 2016. 304 p. (in Russian). ISBN 978-5-9986-0268-9.

12. Guiu B., Quenet F., Panaro F., Piron L., Cassinotto C., Herrerro A., Souche F.R., Hermida M., Pierredon-Foulongne M.A., Belgour A., Aho-Glele S., Deshayes E. Liver venous deprivation versus portal vein embolization before major hepatectomy: future liver remnant volumetric and functional changes. Hepatobiliary Surg Nutr. 2020; 9(5): 564–76. doi: 10.21037/hbsn.2020.02.06.

13. Sidorov D.V., Lozhkin M.V., Petrov L.O., Isaeva A.G. “Saving” a two-stage liver resection by the ALPPS type. Research’n Practical Medicine Journal. 2017; 4(4): 143–48. (in Russian). doi: 10.17709/2409-2231-2017-4-4-15. EDN: ZWLIPX.

14. Chandra P., Sacks G.D. Contemporary Surgical Management of Colorectal Liver Metastases. Cancers (Basel). 2024; 16(5): 941. doi: 10.3390/cancers16050941.

15. Kim D., Cornman-Homonoff J., Madoff D.C. Preparing for liver surgery with “Alphabet Soup”: PVE, ALPPS, TAE-PVE, LVD and RL. Hepatobiliary Surg Nutr. 2020; 9(2): 136–51. doi: 10.21037/hbsn.2019.09.10.

16. Balci D., Sakamoto Y., Li J., Di Benedetto F., Kirimker E.O., Petrowsky H. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure for cholangiocarcinoma. Int J Surg. 2020; 82S: 97–102. doi: 10.1016/j.ijsu.2020.06.045.

17. Sugawara Y., Yamamoto J., Higashi H., Yamasaki S., Shimada K., Kosuge T., Takayama T., Makuuchi M. Preoperative portal embolization in patients with hepatocellular carcinoma. World J Surg. 2002; 26(1): 105–10. doi: 10.1007/s00268-001-0189-y.

18. Schnitzbauer A.A., Lang S.A., Goessmann H., Nadalin S., Baumgart J., Farkas S.A., Fichtner-Feigl S., Lorf T., Goralcyk A., Hörbelt R., Kroemer A., Loss M., Rümmele P., Scherer M.N., Padberg W., Königsrainer A., Lang H., Obed A., Schlitt H.J. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012; 255(3): 405–14. doi: 10.1097/SLA.0b013e31824856f5.

19. Isfordink C.J., Samim M., Braat M.N.G.J.A., Almalki A.M., Hagendoorn J., Borel Rinkes I.H.M., Molenaar .I.Q. Portal vein ligation versus portal vein embolization for induction of hypertrophy of the future liver remnant: A systematic review and meta-analysis. Surg Oncol. 2017; 26 (3): 257–67. doi: 10.1016/j.suronc.2017.05.001.

20. Heil J., Schiesser M., Schadde E. Current trends in regenerative liver surgery: Novel clinical strategies and experimental approaches. Front Surg. 2022; 9: 903825. doi: 10.3389/fsurg.2022.903825.

21. Kishi Y., Madoff D.C., Abdalla E.K., Palavecino M., Ribero D., Chun Y.S., Vauthey J.N. Is embolization of segment 4 portal veins before extended right hepatectomy justified? Surgery. 2008; 144(5): 744–51. doi: 10.1016/j.surg.2008.05.015.

22. Beppu T., Yamamura K., Okabe H., Imai K., Hayashi H. Oncological benefits of portal vein embolization for patients with hepatocellular carcinoma. Ann Gastroenterol Surg. 2020; 5(3): 287–95. doi: 10.1002/ags3.12414.

23. Kokudo N., Tada K., Seki M., Ohta H., Azekura K., Ueno M., Ohta K., Yamaguchi T., Matsubara T., Takahashi T., Nakajima T., Muto T., Ikari T., Yanagisawa A., Kato Y. Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology. 2001; 34(2): 267–72. doi: 10.1053/jhep.2001.26513.

24. Pamecha V., Levene A., Grillo F., Woodward N., Dhillon A., Davidson B.R. Effect of portal vein embolisation on the growth rate of colorectal liver metastases. Br J Cancer. 2009; 100(4): 617–22. doi: 10.1038/sj.bjc.6604872.

25. Sakai N., Clarke C.N., Schuster R., Blanchard J., Tevar A.D., Edwards M.J., Lentsch A.B. Portal vein ligation accelerates tumor growth in ligated, but not contralateral lobes. World J Gastroenterol. 2010; 16(30): 3816–26. doi: 10.3748/wjg.v16.i30.3816.

26. Vyas S., Markar S., Partelli S., Fotheringham T., Low D., Imber C., Malago M., Kocher H.M. Portal vein embolization and ligation for extended hepatectomy. Indian J Surg Oncol. 2014; 5(1): 30–42. doi: 10.1007/s13193-013-0279-y.

27. Deal R., Frederiks C., Williams L., Olthof P.B., Dirscherl K., Keutgen X., Chan E., Deziel D., Hertl M., Schadde E. Rapid Liver Hypertrophy After Portal Vein Occlusion Correlates with the Degree of Collateralization Between Lobes-a Study in Pigs. J Gastrointest Surg. 2018; 22(2): 203–13. doi: 10.1007/s11605-017-3512-0.

28. Koga Y., Beppu T., Imai K., Kuramoto K., Miyata T., Kitano Y., Nakagawa S., Okabe H., Okabe K., Yamashita Y.I., Chikamoto A., Baba H. Complete remission of advanced hepatocellular carcinoma following transient chemoembolization and portal vein ligation. Surg Case Rep. 2018; 4(1): 102. doi: 10.1186/s40792-018-0510-8.