Preoperative portal vein embolization (PVE) is often performed as a routine procedure before extended
hepatectomy to minimize postoperative
liver failure. However, the indications for PVE in
perihilar cholangiocarcinoma (
PCCA), which differ between institutions, remain controversial. In the present study, we examined the indications for PVE in patients with
PCCA. A comprehensive meta-analysis of PVE was performed using the PubMed, Medline, and Cochrane databases. The present study, which included 3033 patients (45 publications), compared the results of 836 cases in the
PCCA group and 2197 cases in the other hepatic
tumor (OHT) group. In the
PCCA group, percent future remnant liver (%FRL) and ratio of %FRL to
indocyanine green (ICG) were used as criteria in 71% and 25% of cases, respectively, and a %FRL < 40% was used as indication for PVE in 90% of cases. The rates of resection of the bile duct, simultaneous
pancreaticoduodenectomy, and reconstruction of the portal vein and hepatic artery were high in the
PCCA group (P < 0.001). Mortality after
hepatectomy was 3.7% in the
PCCA group and 1.9% in the OHT group (P < 0.001). The indication for PVE in
PCCA patients is %FRL < 40% in many institutions. The indications for PVE in
PCCA patients should be distinguished from those in other hepatic
tumors because of the complex surgery required for
PCCA.