308 - Optimizing Future Liver Remnant: Meta-Analysis of Foamed STS Portal Vein Embolization Before Hepatectomy

Purpose: Foamed sodium tetradecyl sulfate (STS) is increasingly used for right portal vein embolization (PVE) prior to hepatectomy to promote future liver remnant (FLR) hypertrophy. Foaming prolongs endothelial contact and enhances sclerosing effect, allowing precise and effective embolization. However, the pooled efficacy of foamed STS in PVE across malignancy types and procedural contexts remains uncertain. We conducted a single-arm meta-analysis to evaluate efficacy outcomes.

Materials and Methods: Databases were searched through September 2025 for studies on foamed STS PVE in patients undergoing hepatic resection for malignant tumors. Outcomes included technical success, clinical success, adequate FLR hypertrophy, and disease progression. Technical success was defined as complete right PVE with patency of the left and main portal veins in a single procedure, clinical success was defined as successful partial hepatectomy, while adequate FLR hypertrophy was defined as achieving an FLR volume of at least 20% of total liver volume (TLV) in patients with normal liver function, at least 30% in those with chemotherapy-associated liver injury, and at least 40% in those with cirrhosis. Single-arm proportional meta-analysis was performed using OpenMetaAnalyst. Heterogeneity was assessed using I².

Results: Four studies with 129 patients were included. Our population consisted of patients with hepatocellular carcinoma, cholangiocarcinoma, invasive gallbladder cancer, and metastatic malignancies. Pooled technical success was 98.3% (95% CI: 95.7-100). Clinical success was 81.8% (74.0-87.6). Adequate FLR hypertrophy was achieved in 96% (92.4-100). Disease progression occurred in 7.9% (2.5-13.3). In one study, mean FLR increase was 46.1% (SD 24.2). Clinical failure was mainly due to disease progression, inadequate hypertrophy, or intraoperative findings. Reported procedural complications included non-target embolization.

Conclusion: Foamed STS appears to be a safe and effective PVE technique in patients undergoing hepatic resection for malignant tumors, with high rates of technical success and FLR hypertrophy. Its performance is comparable to other embolic agents such as NBCA, PVA, and microspheres. Few head-to-head studies exist, representing an opportunity for future research to determine the optimal embolization strategy for FLR optimization.