Preoperative Sequential Portal and Hepatic Vein Embolization in Patients with Hepatobiliary Malignancy.

Abstract

BACKGROUND:

Preoperative portal vein embolization (PVE) induces shrinkage of the embolized lobe and compensatory regeneration in the non-embolized lobe, but does not always induce sufficient regeneration of the future remnant liver (FRL). We previously developed preoperative sequential PVE-hepatic vein embolization (HVE), and here we present our experience of treating 42 patients with sequential PVE-HVE.

METHODS:

During 8-year study period, preoperative PVE-HVE was performed on 42 patients with hepatobiliary malignancies.

RESULTS:

Primary diseases were bile duct cancers [perihilar cholangiocarcinoma (n = 33) and diffuse bile duct cancer (n = 1)], hepatocellular carcinomas (n = 4), and intrahepatic tumors [intrahepatic cholangiocarcinoma (n = 3) and gallbladder cancer liver invasion (n = 1)]. These patients demonstrated insufficient FRL regeneration following PVE, thus HVE was performed to induce further regeneration. No PVE-HVE procedure-associated complications occurred. In the bile duct cancer group, FRL volume was 33.9 ± 2.2 % before PVE, 38.4 ± 1.5 % before HVE, 43.7 ± 2.1 % at surgery, and 73.6 ± 8.3 % at 2 weeks after right hepatectomy. The degree of FRL hypertrophy was 13.3 % after PVE, 28.9 % after PHV-HVE, and 117.1 % at 2 weeks after right hepatectomy. All patients except one recovered uneventfully after surgery, and the 3-year patient survival rate was 45.1 %. In the HCC group, transarterial chemoembolization was initially performed and FRL regeneration following PVE-HVE occurred very slowly. Active FRL regeneration occurred in the liver tumor group, but rapid tumor growth was observed in 1 of 4 patients.

CONCLUSION:

The sequential application of HVE following PVE safely and effectively induces further FRL regeneration in non-cirrhotic livers. Further validation using larger patient population and multicenter studies is needed to reliably widen the indications.

• Authors: Shin Hwang, Tae-Yong Ha, Gi-Young Ko, Dong-Il Kwon, Gi-Won Song, Dong-Hwan Jung, Myung-Hwan Kim, Sung-Koo Lee, Sung-Gyu Lee
• Journal: World journal of surgery (World J Surg) Vol. 39 Issue 12 Pg. 2990-8 (Dec 2015) ISSN: 1432-2323 [Electronic] United States
• PMID: 26304608 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Bile Duct Neoplasms (surgery, therapy)
• Carcinoma, Hepatocellular (surgery, therapy)
• Cholangiocarcinoma (surgery)
• Embolization, Therapeutic
• Female
• Gallbladder Neoplasms (pathology, surgery, therapy)
• Hepatectomy
• Hepatic Veins
• Humans
• Hypertrophy
• Klatskin Tumor (surgery, therapy)
• Liver (pathology, physiology)
• Liver Neoplasms (surgery, therapy)
• Liver Regeneration
• Male
• Middle Aged
• Portal Vein
• Preoperative Care
• Survival Rate
• Treatment Outcome