1. Gi-Won Song, Gi-Young Ko, Dong-Il Gwon
KHBPS
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

2. 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.

3. 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

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

5. 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

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

7. Regeneration of the right liver
Left liver volume
45±2% ±2%
Right liver volume
55±2% ±2% ±3%

8. 70 year-old patient undergone PPPD
44%
40%
Tumor recurrence
after 4 yrs
Left PVE
LL+S1+ HJ revision

9. Comparison between study and control groups
60% % % %
20% % % %

10. 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.

11. 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?