Medical Oncologist
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Portal vein embolisation: growing the liver before surgery | CION Cancer Clinics
Portal vein embolisation blocks the vein feeding the part of the liver that will be removed. Blood is redirected to the part that stays, which grows over the following weeks. The aim is to leave enough healthy liver behind after a major liver operation. It prepares you for surgery rather than treating the cancer. This page explains who it is considered for, what happens and what the waiting weeks involve. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is portal vein embolisation, and why grow the liver first?
- Who might be offered it, and who is not?
- What happens during the procedure?
- What happens in the weeks before the operation?
- What do the words on the scan report mean?
- What do families often get wrong about this procedure?
- Are there other ways to make liver surgery safer?
- Common questions about portal vein embolisation
The short answer
What is portal vein embolisation, and why grow the liver first?
Portal vein embolisation blocks the vein that carries blood to the part of the liver that will be removed. Blood is then sent to the part that will stay, and over the following weeks that part grows larger, so that more liver is left behind after the operation.
Why the size of the leftover liver matters
The liver does jobs you cannot live without. It clears waste from the blood, makes the proteins that help blood clot, and handles most medicines. If a large operation removes too much of it, the piece left behind can struggle to keep up. That is called liver failure after surgery, and it is one of the most serious problems a liver operation can cause.
What the procedure is for
Your surgical team measures, on a scan, how much liver would be left after the planned operation. If that leftover piece looks too small for your body, or your liver has already been strained by chemotherapy, they may suggest growing it first. The procedure does not treat the cancer itself. It prepares the liver so that an operation which looked too risky may become possible.
This page explains the procedure. It cannot tell you whether it is right for you. That depends on your scans, your blood tests and the operation your team is planning.Who it is considered for
Who might be offered it, and who is not?
The decision is made by the liver surgeon and the interventional radiologist together, usually at a tumour board meeting.
Usually considered when
A large part of the liver needs to be removed and the scan suggests the piece left behind would be too small to cope.
Often seen with
- Bowel cancer that has spread to the liver
- Bile duct cancer near the centre of the liver
- Some primary liver cancers
When the liver is already tired
Several rounds of chemotherapy, fatty liver or a blocked bile duct can all leave the liver less able to recover. Teams often ask for more leftover liver in these situations than in a healthy liver.
Usually not suitable when
The liver is badly scarred, the pressure in the portal vein is already high, or the cancer has spread in a way that means surgery is not planned at all. Growing the liver only makes sense if an operation is likely to follow.
Not needed when
The scan shows enough liver will be left. Many people having liver surgery never need this step, and being told you do not need it is not a sign that something has been missed.
Not sure whether this applies to you?
Ask an oncologistOn the day
What happens during the procedure?
Before you go in
You will be asked not to eat for a few hours and to have blood tests that check clotting. Tell the team about every medicine you take, especially blood thinners. They will tell you what to do with each one. Do not stop anything on your own.
Numbing and sedation
The skin over the right side of your belly is numbed, and you are usually given medicine to make you drowsy and relaxed. Some centres use a general anaesthetic instead. Ask which yours will use.
Reaching the vein
Guided by ultrasound and X-ray, the radiologist passes a thin needle through the skin into a branch of the portal vein. A very thin tube is threaded along it, and dye shows the veins on the screen.
Blocking the branches
Tiny particles, coils or a medical glue are placed into the branches feeding the part to be removed. The tube is taken out and the small hole is sealed. You rest in bed for several hours afterwards.
After the procedure
What happens in the weeks before the operation?
Most people go home within a day or two. For the first few days you may have an ache under the right ribs, a mild fever or some sickness. These are usually milder than after chemoembolisation of the liver, and they settle with simple medicines your team prescribes.
The growth scan
The leftover liver grows over several weeks. Your team then repeats a CT or MRI scan and measures its new size. Some teams also look at how quickly it grew, because fast growth suggests the liver is healthy enough to recover after surgery. If the growth is enough, the operation is planned soon after the scan.
If the liver does not grow enough
Sometimes the liver grows less than hoped. Sometimes the cancer grows during the wait, or new spots appear. In either case the team may change the plan. They may add a second procedure, give more chemotherapy, or decide that surgery is no longer the safest route. This is hard news to hear.
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On your report
What do the words on the scan report mean?
- Future liver remnant (FLR)
- The part of the liver that will be left after the operation. This is the piece the procedure is trying to grow.
- Volumetry
- Measuring the size of parts of the liver from a CT or MRI scan, done before the procedure and again afterwards.
- Hypertrophy
- Growth of the liver tissue. A report may describe the growth as a proportion of your whole liver or of your body size.
- Hepatectomy
- An operation to remove part of the liver. A right or extended right hepatectomy removes the larger side.
- Cirrhosis
- Scarring of the liver. A scarred liver grows less well and recovers less well, which changes the plan.
Commonly believed
What do families often get wrong about this procedure?
"Blocking a vein will kill the liver."
Only the branches to the part being removed are blocked. The rest of the liver receives more blood, not less, and it is that extra blood which makes it grow.
"It is a treatment for the cancer."
It is preparation for surgery. It does not shrink the tumour, and on its own it does not change how the cancer behaves. If surgery does not follow, the procedure has done little for the cancer itself.
"The waiting weeks let the cancer spread."
That worry is understandable, and the team takes it seriously. It is one reason they repeat the scan before surgery and sometimes continue chemotherapy in the gap. The wait is there because operating too early, on a liver that is too small, carries its own serious danger.
"If the liver grows, the operation will definitely
go ahead."
Growth is one part of the decision. The final plan also rests on the repeat scan, your blood tests and your general fitness on the day. Ask the team what would make them change their mind.
Other approaches
Are there other ways to make liver surgery safer?
These exist in some specialist centres. Ask your own team which, if any, they use and why.
Approach
What it involves
Blocking the portal vein and a liver vein together
Aims for faster or greater growth by also blocking the outflow
Two-stage liver surgery
Tumours are removed from one side first, the other side later
Splitting the liver in a first operation (ALPPS)
Faster growth, but two major operations close together
Radioembolisation of one side
Treats the tumour and slowly grows the other side over months
Questions we are asked
Common questions about portal vein embolisation
Is portal vein embolisation an operation?
No. It is a procedure done through a needle in the skin, by an interventional radiologist rather than a surgeon. There is no large cut and no stitches. Most people are drowsy but awake, and many go home within a day or two. The main liver operation comes later, once the liver has grown.
Will it hurt?
The skin is numbed first, so you should feel pressure rather than sharp pain when the needle goes in. Afterwards an ache under the right ribs is common for a few days, sometimes with a mild fever. Tell the nurses how much it hurts. Pain medicines work better when they are given early.
How long do we wait before the liver surgery?
Usually several weeks, while the leftover liver grows. The exact gap depends on your team, your liver and whether you are having chemotherapy. The date is normally set after the repeat scan shows how much growth there has been, so expect it to be confirmed only at that point.
What are the risks of the procedure?
Serious problems are uncommon but can happen. They include bleeding, infection, a leak of bile, and a clot spreading into the branch of the vein that should stay open. Your radiologist should explain these, and how they are handled, before you sign the consent form. Ask them what they see most often.
My father has diabetes and a fatty liver. Can he still have it?
Often yes, but these conditions matter. A fatty liver may grow more slowly, and teams usually want a larger leftover piece before operating. His sugar control also needs attention around the procedure. Share every report and medicine list with the team so they can plan around them.
Does the cancer grow while we wait?
It can, and teams watch for it. The repeat scan checks both the liver growth and the cancer. Some patients continue chemotherapy during the gap to keep the cancer in check. Ask your medical oncologist whether that applies to you, and what the team would do if the scan showed new disease.
What if the operation is cancelled after the procedure?
That is a hard moment for any family. It usually means the team found that surgery would carry too much danger, or would not remove all the cancer. Other treatments such as chemotherapy, targeted medicines or procedures on the liver may still be offered. Ask for a meeting to go through the options calmly.
Is it covered by Aarogyasri or insurance?
Cover depends on your scheme and on the procedure being part of an approved treatment plan. Aarogyasri, CGHS, ECHS, EHS and cashless insurance all have their own rules. Call the helpline with your card details and the planned procedure, and the team will check what your own cover allows before you travel.
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Sources
- Cancer Research UK — Surgery for liver cancer
- NHS — Liver cancer: treatment
- American Cancer Society — Liver cancer
- National Cancer Institute — NCI Dictionary of Cancer Terms
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Liver Function Before and After EmbolisationThe blood tests that show how the liver is copingPre-Operative Embolisation Before Tumour SurgeryA different embolisation used before an operationTACE vs TARE: How They DifferThe liver procedures that treat the tumour itselfFitness, Tests and PrehabilitationGetting stronger in the weeks before a big operation
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