Liver: portal vein embolisation: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Liver: portal vein embolisation

Sample item

A 62-year-old man with colorectal liver metastases confined to the right lobe needs a right hepatectomy. He has a normal background liver and CT volumetry shows a future liver remnant of 15% of total liver volume. What is the most appropriate step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Right portal vein embolisation to induce hypertrophy of the left lobe

A normal liver generally needs a future remnant of at least about 20 to 25% of total volume to avoid post-hepatectomy liver failure, with higher thresholds in cirrhosis or after chemotherapy. When the remnant is too small, portal vein embolisation of the side to be resected redirects flow and causes hypertrophy of the remnant over several weeks, after which resection can proceed.

Option by option

  • A. Proceed straight to right hepatectomy

    Resecting with only 15% remnant carries a high risk of postoperative liver failure.

  • B. Right portal vein embolisation to induce hypertrophy of the left lobe (correct)

    Correct. Embolising the right portal vein hypertrophies the left lobe before resection.

  • C. Hepatic vein ligation of the left lobe

    Ligating the remnant's venous outflow would cause congestion and infarction of the remaining liver.

  • D. Transjugular intrahepatic portosystemic shunt

    A portosystemic shunt diverts portal flow from the liver and would worsen remnant function.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Right portal vein embolisation to induce hypertrophy of the left lobe. A normal liver generally needs a future remnant of at least about 20 to 25% of total volume to avoid post-hepatectomy liver failure, with higher thresholds in cirrhosis or after chemotherapy.

Why is "Proceed straight to right hepatectomy" not the answer?

Resecting with only 15% remnant carries a high risk of postoperative liver failure.

Why is "Hepatic vein ligation of the left lobe" not the answer?

Ligating the remnant's venous outflow would cause congestion and infarction of the remaining liver.

Why is "Transjugular intrahepatic portosystemic shunt" not the answer?

A portosystemic shunt diverts portal flow from the liver and would worsen remnant function.

What concept does this question test?

It tests Liver: portal vein embolisation in General Surgery. When the remnant is too small, portal vein embolisation of the side to be resected redirects flow and causes hypertrophy of the remnant over several weeks, after which resection can proceed.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Liver: portal vein embolisation?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.