Indications for portal vein embolization in perihilar cholangiocarcinoma

  Preoperative portal vein embolization ( PVE ) is often performed as a routine procedure before extended hepatectomy to minimize postoperative liver failure. However, the indications for PVE in perihilar cholangiocarcinoma ( PCCA ), which differ between institutions, remain controversial. In the present study, we examined the indications for PVE in patients with PCCA . A comprehensive meta‐analysis of PVE was performed using the PubMed , M edline, and C ochrane databases. The present study, which included 3033 patients (45 publications), compared the results of 836 cases in the PCCA group and 2197 cases in the other hepatic tumor ( OHT ) group. In the PCCA group, percent future remnant liver (% FRL ) and ratio of % FRL to indocyanine green ( ICG ) were used as criteria in 71% and 25% of cases, respectively, and a % FRL < 40% was used as indication for PVE in 90% of cases. The rates of resection of the bile duct, simultaneous pancreaticoduodenectomy, and reconstruction of the portal vein and hepatic artery were high in the PCCA group ( P < 0.001). Mortality after hepatectomy was 3.7% in the PCCA group and 1.9% in the OHT group ( P < 0.001). The indication for PVE in PCCA patients is % FRL < 40% in many institutions. The indications for PVE in PCCA patients should be distinguished from those in other hepatic tumors because of the complex surgery required for PCCA .