Elsevier

Surgery

Volume 143, Issue 4, April 2008, Pages 476-482
Surgery

Original Communication
Preoperative contralateral portal vein embolization before major hepatic resection is a safe and efficient procedure: A large single institution experience

https://doi.org/10.1016/j.surg.2007.12.006Get rights and content

Background

The aim of this study was to report the results of preoperative contralateral portal vein embolization (PVE) performed in a single institution.

Methods

Between January 1997 and March 2006, 146 patients requiring a right or extended right hepatectomy for primary or secondary liver tumors underwent contralateral PVE when the future remnant liver volume (FRL) was less than 30% of total liver. Liver volumes and hepatic function were evaluated before and after PVE.

Results

Contralateral PVE was performed successfully in 145 patients. In one patient, the catheterization of the left portal branch failed. Complications occurred in 14 patients (10%) including a transitory fever (n = 9), a parenchymal hematoma (n = 1), a mild hemoperitoneum (n = 1), a mesenterico-portal venous thrombosis (n = 1), a pulmonary embolism (n = 1) and a systemic sepsis (n = 1). The prothrombine ratio and the platelet count were significantly lower 3 days after PVE. Insufficient hypertrophy of the FRL was observed in 8 patients, malignant disease progression in 15, and both insufficient hypertrophy and disease progression in 4. The hypertrophy rate of the FRL 4 to 8 weeks after PVE was 47.7 ± 31.9%. Pathological type of the liver tumor, cirrhosis, diabetes mellitus, and chemotherapy did not affect the volume of the left liver hypertrophy. However, the time required to achieve an adequate liver hypertrophy was significantly shorter in patients with normal liver. One-hundred and fourteen patients (78.6%) subsequently underwent hepatic resection.

Conclusions

The results suggest that contralateral PVE is a safe and efficient procedure inducing adequate hypertrophy of the FRL before major liver resection.

Section snippets

Patients

Between January 1997 and March 2006, a total of 146 patients underwent a right, percutaneous PVE with or without embolization of the portal branches of segment IV through a contralateral approach before right hepatectomy or extended right hepatectomy. Among these patients, the predicted FRL was <30% (for normal parenchyma) and 40% (for cirrhotic or injured parenchyma) of the total functional liver volume. All PVE were performed in our institution by a single interventional radiologist (M.G.).

Success of PVE

Contralateral PVE was performed successfully in 145 of 146 patients (99%). In 1 patient, the left portal vein was not accessible for catheterization after repeated attempts probably because the diameter was too small. This patient underwent operative ligation of the right portal vein followed by liver resection 2 months later. In 122 patients (84%), a right PVE was conducted, whereas 23 patients (16%) had right PVE with embolization of the portal branches of segment IV.

Morbidity and mortality after PVE

The post-PVE course was

Discussion

The current study suggests that percutaneous, contralateral PVE can be performed with a high rate of success (99%) and with a low mortality and morbidity. When PVE is used the planned hepatectomy is then performed in most patients (79%). Cirrhosis, chemotherapy, and diabetes mellitus did not appear to affect the volume of the FRL hypertrophy in our series. A mild and transitory but not clinically relevant decrease of prothrombin time and platelet count was observed after PVE.

Liver resection is

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