A 65-year-old patient is scheduled for right hepatectomy. Preoperative CT volumetry shows future liver remnant (FLR) of 22% of total liver volume. To prevent post-hepatectomy liver failure, the most appropriate preoperative intervention is:

• A Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)
• B Portal vein embolization (PVE) of the right portal vein ✓
• C Neoadjuvant chemotherapy to shrink the tumor and allow larger FLR
• D Proceed directly to hepatectomy as FLR >20% is adequate

Explanation

Portal vein embolization (PVE) of the right portal vein induces compensatory hypertrophy of the left FLR through regeneration stimulated by redirected portal blood flow, typically increasing FLR by 8–15% over 4–8 weeks. An FLR of <25% in a normal liver (or <40% in a cirrhotic liver) is associated with post-hepatectomy liver failure. PVE is the standard technique to augment FLR before major hepatectomy. ALPPS achieves faster FLR growth (1–2 weeks) but carries higher morbidity and mortality and is reserved for specific situations where PVE is inadequate or fails.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.