Efficacy and safety of temporary selective portal vein embolization before major hepatectomy (EMBORES): a phase 2 trial

@article{tranchart2026efficacy,
  title = {{Efficacy and safety of temporary selective portal vein embolization before major hepatectomy (EMBORES): a phase 2 trial}},
  author = {Hadrien Tranchart and Sophie Maitre and Edouard Girard and Julien Ghelfi and Maximiliano Gelli and Lambros Tselikas and Maxime Barat and David Fuks and Anthony Sarran and Stéphane Benoist and Olivier Meyrignac and Ailton Sepulveda and Maxime Ronot and Maryne Pou and Mircea Chirica and Ibrahim Dagher and Christian Sengel and Antoine Brouquet and Brice Gayet and Valérie Vilgrain and François Cauchy and Olivier Soubrane and Leonor Benhaim and Dimitri Tzanis: and Yves Menu and Sébastien Gaujoux and Laurence Rocher and Georges Rafek: and Pierre Chague and Thierry De Baere and Diane Goere and Mickaël Lesurtel and Panagiotis Lainas and Martin Gaillard and Joseph Derienne and Marco Dioguardi Burgio and Annie Sibert and Alain Abdo and Teodor Vasile and Severine Foucher and Marie Chalopin and Thibault Chouquet and Sandra Camps and Steve Suzzoni and Pierrick Bedouch and Marylise Adechian and Hélène Agostini and Lamiae Grimaldi and Kawther Nheri and Fatah Tidadini and Olivier Soubrane and Jean-Baptiste Debry},
  journal = {eClinicalMedicine},
  year = {2026},
  month = oct,
  doi = {10.1016/j.eclinm.2026.104262},
  url = {https://linkinghub.elsevier.com/retrieve/pii/S2589537026005158},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Efficacy and safety of temporary selective portal vein embolization before major hepatectomy (EMBORES): a phase 2 trial
AU  - Hadrien Tranchart
AU  - Sophie Maitre
AU  - Edouard Girard
AU  - Julien Ghelfi
AU  - Maximiliano Gelli
AU  - Lambros Tselikas
AU  - Maxime Barat
AU  - David Fuks
AU  - Anthony Sarran
AU  - Stéphane Benoist
AU  - Olivier Meyrignac
AU  - Ailton Sepulveda
AU  - Maxime Ronot
AU  - Maryne Pou
AU  - Mircea Chirica
AU  - Ibrahim Dagher
AU  - Christian Sengel
AU  - Antoine Brouquet
AU  - Brice Gayet
AU  - Valérie Vilgrain
AU  - François Cauchy
AU  - Olivier Soubrane
AU  - Leonor Benhaim
AU  - Dimitri Tzanis:
AU  - Yves Menu
AU  - Sébastien Gaujoux
AU  - Laurence Rocher
AU  - Georges Rafek:
AU  - Pierre Chague
AU  - Thierry De Baere
AU  - Diane Goere
AU  - Mickaël Lesurtel
AU  - Panagiotis Lainas
AU  - Martin Gaillard
AU  - Joseph Derienne
AU  - Marco Dioguardi Burgio
AU  - Annie Sibert
AU  - Alain Abdo
AU  - Teodor Vasile
AU  - Severine Foucher
AU  - Marie Chalopin
AU  - Thibault Chouquet
AU  - Sandra Camps
AU  - Steve Suzzoni
AU  - Pierrick Bedouch
AU  - Marylise Adechian
AU  - Hélène Agostini
AU  - Lamiae Grimaldi
AU  - Kawther Nheri
AU  - Fatah Tidadini
AU  - Olivier Soubrane
AU  - Jean-Baptiste Debry
PY  - 2026
DA  - 2026/10/12
JO  - eClinicalMedicine
DO  - 10.1016/j.eclinm.2026.104262
UR  - https://linkinghub.elsevier.com/retrieve/pii/S2589537026005158
AB  - Background  Portal vein embolization (PVE) is routinely used before major hepatectomy to induce hypertrophy of the future liver remnant (FLR) and reduce post-hepatectomy liver failure. Conventional PVE relies on permanent embolic agents, resulting in irreversible portal occlusion, which may be associated with complications and may limit subsequent therapeutic options in patients who do not ultimately undergo resection. Whether transient portal deprivation alone can induce clinically relevant liver regeneration remains unknown. We evaluated the efficacy and safety of temporary selective PVE using an absorbable gelatin agent.Methods  EMBORES was a multicenter prospective single-arm phase II trial conducted in six French hepatobiliary centers. Between May 3, 2018, and May 3, 2021, adult patients requiring major hepatectomy and preoperative PVE were included. Selective portal branches were embolized using powdered absorbable gelatin sponge. The primary endpoint was FLR hypertrophy assessed by computed tomography (CT) volumetry 4-6 weeks after PVE. Secondary endpoints included feasibility, morbidity, portal vein recanalization, and surgical outcomes. This trial is registered with ClinicalTrials.gov, NCT02945059.Findings  34 patients were enrolled and 32 underwent temporary PVE. Mean age was 63.4 years (standard deviation [SD] 8.9), and colorectal liver metastases accounted for 18 (56%) of 32 indications. Technical success was achieved in all patients. One major complication occurred (1 [3.1%] of 32 patients), while liver function remained preserved. Complete and partial portal vein recanalization were observed in 17 (53%) and 9 (28%) of 32 patients, respectively. Mean FLR volume increased from 580 (SD 169) mL to 690 (SD 188) mL, corresponding to a mean hypertrophy ratio of 9.5% (SD 10.2). Five patients required repeat embolization using a permanent agent because of insufficient hypertrophy. Overall, 23 (71.8%) of 32 patients underwent major hepatectomy, with no postoperative mortality.Interpretation  Temporary PVE using an absorbable embolic agent is feasible, safe, and capable of inducing clinically meaningful liver hypertrophy before major hepatectomy, supporting the concept that transient portal vein occlusion may be sufficient to stimulate liver regeneration in selected patients.Funding  The EMBORES study was funded by the French Ministry of Health through a national hospital clinical research program grant awarded in 2015 (Programme Hospitalier de Recherche Clinique National, PHRC-15-15-0201).
SN  - 2589-5370
ER  -