Efficacy of Sequential Hepatic Vein Embolization Following Portal Vein Embolization in Promoting Regeneration of Liver Volume and Function Before Right‐Sided Major Hepatectomy

Background/Purpose This study compared the efficacy of sequential hepatic vein embolization (HVE) following portal vein embolization (PVE) with PVE alone in promoting both the volume and function of the future remnant liver (FRL) before right‐sided major hepatectomy. Methods All patients underwent preoperative PVE with or without sequential HVE, followed by right hepatectomy ± extended from 2018 to 2023. Changes in FRL volume and function were analyzed and compared between groups, with liver function assessed using technetium‐99m diethylenetriaminepentaacetic acid‐galactosyl‐human serum albumin ( 99m Tc‐GSA) scintigraphy. Results Eight patients underwent sequential PVE–HVE, while 24 underwent PVE alone. All patients underwent embolization without severe complications. The median regeneration rate of FRL volume was significantly higher in the sequential HVE–HVE group at 35.5% (20.6%–54.0%) compared with 26.2% (19.2%–31.0%) in the PVE group ( p = 0.017). Moreover, the median FRL function regeneration rate was 59.5% (41.6%–80.9%) in the sequential PVE–HVE group, markedly greater than the rate of 25.2% (1.2%–41.4%) in the PVE group ( p = 0.014). There was no significant difference in surgical outcomes between groups. Conclusions Sequential PVE–HVE is safe and practical, leading to a significant increase in both the volume and function of the FRL.