Feasibility and Safety of Laparoscopic Portal Vein Ligation Prior to Major Hepatectomy for Hepatocellular Carcinoma

Background: Patients with hepatocellular carcinoma (HCC) demonstrated to have an inadequate future liver remnant (FLR) on preoperative volumetric assessment are potential candidates for laparoscopic portal vein ligation (LPVL). Previous studies have reported that for patients with hepatic malignancies, laparoscopic portal vein ligation (LPVL) is efficient in increasing FLR, which, however, has not been solely reported in HCC. The purpose of this study was to evaluate the safety, feasibility and efficiency of LPVL prior to major hepatectomy for patients with HCC. Methods: Clinical information of HCC patients who had undergone laparoscopic portal vein ligation (LPVL) at our center was retrospectively reviewed and documented. Demographic, radiographic, clinical and volumetric details (both before and after LPVL) were retrieved to evaluate the feasibility and safety of LPVL prior to major hepatectomy for HCC. Results: Between April 2020 and December 2021, there were a total of 10 HCC patients undergoing LPVL as a preparation for subsequent major hepatectomy at our center. The mean age of these 10 patients was 61.30±8.83 years old. Of these 10 patients, 9 were male and only 1 was female. 9 patients underwent laparoscopic ligation of the right portal vein and one the left portal vein. All the patients, left or right portal veins were ligated by clips. After LPVL, the mean volume increased from 433.16±103.64 ml to 550.62±123.19 ml (P＜0.001）. All the 10 patients had adequate hypertrophy of FLR and subsequent major hepatectomy was performed as scheduled. No LPVL-associated complications were recorded. Conclusion: LPVL is both feasible and could be safely performed. For carefully selected patients, LPVL could be considered as a safe and feasible alternative to portal vein embolization (PVE) given the rather low complication rate and high efficiency of LPVL.