Usefulness and safety of preoperative portal vein embolization in older adults: A STROBE-compliant observational study

With the continuing global trend of population aging, the number of older patients who require hepatectomy for malignant or benign liver diseases is steadily increasing. Postoperative liver failure remains one of the major causes of mortality after major hepatic resection, particularly among patients with limited hepatic reserve. Preoperative portal vein embolization (PVE) has been established as a safe and effective method to increase the future remnant liver volume (RLV), thereby improving postoperative outcomes. However, the regenerative capacity of the aged liver and the clinical benefits of PVE in older patients have not been fully clarified. This study aimed to assess the safety and efficacy of PVE in older patients compared with younger counterparts. We analyzed 113 patients who underwent PVE at Hokkaido University Hospital between 2000 and 2020. Patients were classified into 2 groups: 30 older patients (≥75 years; older group) and 83 younger patients (<75 years; younger group). We compared the patients' characteristics, PVE-related factors, period from PVE to surgery, increase in RLV after PVE, and perioperative complications. Right hepatectomy was the most common surgical procedure (76.1%). The increase in RLV 2 weeks after PVE was comparable between the older (131.9%) and younger (130.3%) groups, and the period from PVE to surgery was also comparable (29 vs 26 days. respectively). Additionally, planned surgeries were completed successfully in all older patients. PVE-related complications were comparable, with recanalization of the embolic portal branch in 2 cases (6.7%) in the older group and 11 cases (13.3%) in the younger group. The liver failure rate, as a postoperative complication, was similar in the groups. Despite concerns regarding the diminished hepatic regenerative potential associated with aging, preoperative PVE effectively induces hypertrophy of the future remnant liver and may enable safe major hepatectomy in older patients. Although our findings suggest comparable outcomes between older and younger patients, these results should be interpreted with caution. PVE may be a safe and useful strategy in appropriately selected older patients requiring major liver resection.