Analysis of Preoperative Portal Vein Embolization Outcomes in Patients with Hepatocellular Carcinoma: A Single-Center Experience

Abstract Purpose To analyze outcomes of patients with hepatocellular carcinoma (HCC) undergoing preoperative portal vein embolization (PVE). Materials and Methods A retrospective analysis of survival, recurrence, and complications was performed in 82 patients with HCC undergoing preoperative PVE and surgical treatment with curative intention from June 2006 to December 2014. Results Rate of major adverse events after PVE was 11% with no mortality. Twenty-eight (34.1%) patients showed radiologic progression of HCC after PVE; 72 patients (87.8%) eventually were accepted as surgical candidates. Median interval between PVE and surgery was 37 days, and 69 patients (84.1%) ultimately underwent surgical resection. At 1 and 3 years, disease-free survival rates were 81.3% and 53.1%, respectively, and overall patient survival rates were 77.5% and 63.1%. Compared with patients accepted as surgical candidates, patients who did not undergo surgery had a higher median number of HCC tumors (1 [range, 1–5] vs 2 [range, 1–4], P  = .031). At 1 and 3 years, patients with disease progression after PVE but who still underwent surgical resection showed similar recurrence-free (90% vs 79.6% and 75% vs 48.6%) and overall (72.2% vs 78.4% and 57.8% vs 64%) survival rates as the rest of the patients who underwent resection. Conclusions PVE is a safe technique with good outcomes that potentially increases the number of patients with initially unresectable HCC who can be offered resection. Radiologic progression after PVE should not be seen as a contraindication to offer resection if it is still deemed possible.