This systematic review evaluates whether hepatic and portal vein embolisation is more effective and safer in comparison to portal vein embolisation for volume optimisation in patients prior to major hepatectomy.

A total of three retrospective comparative studies and two prospective case series were included. Simultaneous hepatic and portal vein embolisation seems to be the preferred technique compared to sequential portal and hepatic vein embolisation, as the delay for surgery is reduced, and it can be performed as a dual procedure instead of two separate procedures. However, future liver remnant hypertrophy seems to be greater and faster with hepatic and portal vein embolisation than portal vein embolisation alone, whereas it did not appear to improve the unresectability due to disease progression or reduce the time between embolisation and resection.

Hepatic and portal vein embolisation appears to be as safe as portal vein embolisation alone. No conclusion can be made whether hepatic and portal vein embolisation leads to better outcomes than the first-line comparator portal vein embolisation.