Review The role of portal vein embolization in the surgical management of primary hepatobiliary cancers. A systematic review G.K. Glantzounis a, * , E. Tokidis a , S.-P. Basourakos a , E.E. Ntzani b , G.D. Lianos a , G. Pentheroudakis c a Department of Surgery, School of Medicine, University of Ioannina, Ioannina, Greece b Evidence-based Medicine Unit, Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece c Department of Medical Oncology, School of Medicine, University of Ioannina, Ioannina, Greece Accepted 23 May 2016 Available online --- Abstract Background: Primary liver and biliary cancers are very aggressive tumors. Surgical treatment is the main option for cure or long term sur- vival. The main purpose of this systematic review is to underline the indications for portal vein embolization (PVE), in patients with inad- equate future liver remnant (FLR) and to analyze other parameters such as resection rate, morbidity, mortality, survival after PVE and hepatectomy for primary hepatobiliary tumors. Also the role of trans-arterial chemoembolization (TACE) before PVE, is investigated. Methods: A systematic search of the literature was performed in Pub Med and the Cochrane Library from 01.01.1990 to 30.09.2015. Results: Forty articles were selected, including 2144 patients with a median age of 61 years. The median excision rate was 90% for hepa- tocellular carcinomas (HCCs) and 86% for hilar cholangiocarcinomas (HCs). The main indications for PVE in patients with HCC and pres- ence of liver fibrosis or cirrhosis was FLR <40% when liver function was good (ICGR15 < 10%) and FLR < 50% when liver function was affected (ICGR15:10e20%). The combination of TACE and PVE increased hypertrophy rate and was associated with better overall survival and disease free survival and should be considered in advanced HCC tumors with inadequate FLR. In patients with HCs PVE was per- formed, after preoperative biliary drainage, when FLR was <40%, in the majority of studies, with very good post-operative outcome. How- ever indications should be refined. Conclusion: PVE before major hepatectomy allows resection in a patient group with advanced primary hepato-biliary tumors and inade- quate FLR, with good long term survival. Ó 2016 Published by Elsevier Ltd. Keywords: Portal vein embolization (PVE); Primary liver cancer; Biliary cancer; Liver resection; Hepatectomy; Hepatocellular carcinoma (HCC); Intrahe- patic cholangiocarcinoma (IHC); Hilar cholangiocarcinoma (HC) Introduction Primary hepatobiliary tumors, which mainly include he- patocellular carcinoma (HCC), intrahepatic cholangiocarci- noma (IHC) and hilar cholangiocarcinoma (HC) are very aggressive tumors with mean survival less than one year if left untreated. 1e3 HCC is the second leading cause of cancer-death world- wide. Surgical treatment (liver transplantation and hepatic * Corresponding author. Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece. Tel.: þ30 2651099695; fax: þ30 2651099890. E-mail addresses: gglantzounis@uoi.gr, gglantzounis@gmail.com (G.K. Glantzounis). http://dx.doi.org/10.1016/j.ejso.2016.05.026 0748-7983/Ó 2016 Published by Elsevier Ltd. Available online at www.sciencedirect.com ScienceDirect EJSO xx (2016) 1e10 www.ejso.com Please cite this article in press as: Glantzounis GK, et al., The role of portal vein embolization in the surgical management of primary hepatobiliary can- cers. A systematic review, Eur J Surg Oncol (2016), http://dx.doi.org/10.1016/j.ejso.2016.05.026