Portal vein embolization (PVE) is performed preoperatively in patients with hepatocellular carcinoma scheduled for major hepatectomy when the estimated future liver remnant (FLR) is below which threshold in a patient with underlying cirrhosis?

• A 10% of total liver volume
• B 20% of total liver volume
• C 50% of total liver volume
• D 40% of total liver volume ✓

Explanation

In patients with normal liver parenchyma, FLR of >25–30% is considered adequate for safe hepatectomy. However, in patients with cirrhosis, underlying fibrosis, or chemotherapy-associated liver injury, a minimum FLR of 40% is required before major resection to prevent post-hepatectomy liver failure. Portal vein embolization of the lobe to be resected induces hypertrophy of the contralateral lobe over 4–6 weeks, increasing FLR to the safe threshold.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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