Preoperative Portal Vein Embolization Is Not Associated with Increased Postoperative Complications After Major Hepatectomy: a Study of the National Surgical Quality Improvement Database

Background: Preoperative portal vein embolization (PVE) is selectively performed to induce hypertrophy of the future liver remnant prior to major liver resection. The primary aim of this study was to determine the association of PVE with liver-specific and overall postoperative morbidity. Methods: A retrospective cohort study of patients who underwent major hepatectomy from 2014 to 2016 within the ACS-NSQIP hepatectomy-specific module was performed. Results: Of the 3912 patients identified, 9.9% (N = 388) underwent PVE. Patients who underwent PVE were older (59.1 vs. 57.7 years). Most patients in the PVE cohort underwent right hepatectomy (51.8%, N = 201) or trisectionectomy (46.1%, N = 179), compared with right (49.3%, N = 1738) and left hepatectomy (29.6%, N = 1042) in the non-PVE cohort (p < 0.001). Median operative time was longer in the PVE group (310 vs. 276 min, p < 0.001). Post-hepatectomy liver failure was more common among patients undergoing PVE (18.6% (N = 72) vs. 9.9% (N = 350), p < 0.001), as was bile leak (17.3% (N = 67) vs. 12.2% (N = 428), p = 0.005). Overall complication rates were higher among patients who underwent PVE (45.9% (N = 178) vs. 34.0% (N = 1199), p < 0.001). However, on multivariable analysis controlling for patient and technical factors, PVE remained associated with an increased risk of liver-specific complications (OR 1.33, 95% CI 1.01–1.74) but not with overall complications (OR 1.17, 95% CI 0.92–1.50). Conclusion: Within a national cohort, patients treated with PVE are older and undergo a more extensive liver resection. When controlling for patient and technical factors, PVE is neither associated with an increase in overall morbidity nor mortality, suggesting that PVE can be safely used in appropriate patients undergoing major hepatectomy.