Ultrasound guided liver resection: does this approach limit the need for portal vein embolization?

Background/Aims: Major hepatectomy is associated with higher risks of morbidity and mortality. Portal vein embolization (PVE) has been advocated to minimize those risks. However, PVE itself has associated drawbacks. The use of ultrasound-guided liver resection minimizes the need for major resection, and might reduce the use of PVE. The aim of this study was to validate this hypothesis. Methodology: Two hundred and ninety-eight consecutive patients who underwent liver surgery were reviewed. Eighty-five of these patients with tumors corresponding to right 1st/2nd order portal branches (Zone P) and right hepatic vein (Zone H) were selected as potential candidates for major hepatectomy and PVE. Indications to PVE were based on the most recent reported criteria. Surgical strategy was based on the relationship between the tumor and the intrahepatic vascular structures at intraoperative ultrasonography (IOUS). Results: Thirty-six (42%) patients with tumors located in Zones H and P were potential candidates to PVE, but none underwent this procedure. Major hepatecomies were performed in 10 (12%) patients. No hospital mortality was seen. Morbidity rate was 19% and major morbidity occurred in 2 patients. Blood transfusion rate was 12%. Mean tumor-free margin was 0.1 cm (median 0.1; range 0-0.6). None had local recurrence after a mean follow-up of 28 months (median 27; range 6-68). Conclusions: IOUS guidance allows an alternative, safe, and effective surgical approach for patients generally submitted to major hepatectomy and most of them to preoperative PVE. In this perspective, further studies are required to reassess indications to PVE.