**5.2 Portal vein embolization**

Based on objective date, consensus has been reached on what is an adequate liver remnant and what are the "safe" resection percentages depending on the quality and health of the liver (Zorzi et al. 2007). Figure 2.

Fig. 2. Minimum FLR volume needed for safe liver resection in patients with normal, intermediate disease or cirrhotic liver (Zorzi et al. 2007).

When the future liver remnant (FLR) is insufficient PVE should be considered. PVE also constitutes a dynamic pre-operative test on the capacity of the liver to respond to the surgical aggression. If a hypertrophy greater than 5% is achieved after PVE, there is a low risk of a terrible post-operative liver insufficiency (Ribero et al. 2007). Chemotherapy does not seem to affect the hypertrophy induced by PVE. A few studies using bevazucimab recommend a 6 week waiting period between the last dose and the hepatectomy, although its influence on the hypertrophy is unclear.

PVE is well tolerated with minimum side effects such as fever, nausea, and transient abnormality of liver function test. The complication rate is below 5% (Abdallah et al. 2001). Azoulay et al. reported that PVE increased the feasibility of liver resection by 19% and that the actuarial survival rate was 40% at 5 years, similar to that of patients resected without PVE (Azoulay et al. 2000).
