Direct tumor invasion of a lobar portal vein branch may lead to ipsilateral hepatic lobe atrophy and contralateral lobe hypertrophy. The development of compensatory hypertrophy of a lobe or segments of the liver after tumor occlusion of contralateral portal venous branches led to the concept of planned portal vein embolization (PVE) to initiate hypertrophy in segments of the liver that would remain following a major liver resection. PVE as a potentially useful treatment to induce hepatic hypertrophy before liver resection was first reported in a small group of HCC patients in 1986. These patients also underwent hepatic arterial embolization of their primary liver tumor, but the PVE was noted to induce hypertrophy rarely seen with hepatic arterial embolization alone. Interest in preoperative PVE has increased because extended hepatectomy (resection of 5 or more hepatic segments) is now more frequently considered an appropriate and safe treatment option for patients with hepatobiliary malignancies.
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