Transarterial therapies versus portal vein embolization prior to major hepatectomy: A national comparison of perioperative outcomes.

Abstract

Background: Preoperative liver remnant hypertrophy has historically been achieved with portal vein embolization, but transarterial embolizations, such as radioembolization, have gained interest as alternative hypertrophy mechanisms in select patients. National practice patterns and outcomes between these 2 modalities are poorly characterized. The objective of this study is to compare preoperative utilization of transarterial therapies versus portal vein embolization and assess perioperative outcomes.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing right hepatectomy or trisegmentectomy after preoperative portal vein embolization or transarterial embolization between 2014 and 2024. Univariable and multivariable regression analyses were performed to identify factors associated with utilization, perioperative transfusion, posthepatectomy liver failure, and serious morbidity.

Results: Among 1,240 patients who met inclusion criteria, 1,068 (86.1%) underwent portal vein embolization and 172 (13.9%) underwent transarterial embolization. Transarterial embolization utilization increased from 8.8% in 2014 to 23.7% in 2024 (P < .001). In multivariable analysis, patients were more likely to receive transarterial embolization if they underwent resection in 2020 and after (odds ratio, 2.17; 95% confidence interval, 1.46-3.26; P < .001) or had hepatocellular carcinoma (odds ratio, 4.35; 95% confidence interval, 2.41-7.99; P < .001). Rates of transfusion (374/1,068 [35.0%] vs 61/172 [35.5%], P = .978), serious posthepatectomy liver failure (120/1,068 [11.2%] vs 17/172 [9.9%], P = .695), and serious morbidity (391/1,068 [36.6%] vs 59/172 [34.3%], P = .618) were comparable between portal vein embolization and transarterial embolization, respectively, with no further differences on adjusted multivariable analysis.

Conclusion: Utilization of transarterial embolization prior to major hepatectomy has increased over the past decade with no associated increase in relative morbidity. In appropriate clinical scenarios, transarterial embolization may serve as a reasonable alternative to portal vein embolization prior to major hepatectomy.