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.