Gi-Won Song, Gi-Young Ko, Dong-Il Gwon KHBPS 2016.04.01 Preoperative left portal vein embolization for left liver resection in high-risk hepatobiliary malignancy patients Shin Hwang, Gi-Won Song, Gi-Young Ko, Dong-Il Gwon

Why left PVE? Not to prevent post-hepatectomy hepatic failure To reduce postoperative complications in old-aged high-risk patients because major liver surgery in old-aged patients is not always safe.

Indications Liver resection rate ≥ 40% of TLV (Left hepatectomy ± S1 resection ± BDR) Age > 60 yrs with major co-morbidity Age ≥ 70 yrs with poor general condition

d Left PVE procedure Post-PVE waiting for 1-2 weeks Contralateral approach d Ipsilateral approach

Study design Retrospective case-controlled study Study group: n=10 Sep 2008~Jul 2015 3% of total PVE cases Control group: Left hepatectomy, propensity score matched. - Small-sized left liver (≤ 35% of TLV): n=40 - Medium-sized left liver (35-40%): n=40 - Large-sized left liver (≥ 40% of TLV): n=40 Comparison of postoperative complications

Study group profiles Age: 69±7 yrs Waiting: 13±5 days ICC-like 5; Klatskin-like 5 Waiting: 13±5 days HJ-stomy: 7

Regeneration of the right liver Left liver volume 45±2% 41±2% Right liver volume 55±2% 59±2% 70±3%

70 year-old patient undergone PPPD 44% 40% Tumor recurrence after 4 yrs Left PVE LL+S1+ HJ revision

Comparison between study and control groups 60% 50% 63% 70% 20% 35% 25% 18%

Conclusions Left PVE is safe and effectively induces atrophy of the LL. Functionally, left PVE converted the large-sized LL to small-sized LL. Left PVE may reduce the risk of postoperative complications, especially in elderly patients with co-morbidities or who are in a poor overall condition.

Old-age patients with obstructive jaundice During biliary decompression, What can we do? Just waiting for 1-3 weeks? Do PVE and wait for 1-3 weeks! How to cope with ongoing risk?