Preoperative Portal Vein Embolization Tailored to Prepare the Liver for Complex Resections: Initial Experience

Journal Article · Fri Oct 15 00:00:00 EDT 2010 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-009-9785-2· OSTI ID:21428927

Robinson, J M; Deschamps, F; Rao, P; Teriitheau, C; Goere, D; Elias, D ^[1]

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1. Institut Gustave Roussy, Department of Radiology (France)

The purpose of this study was to evaluate the safety and efficacy of preoperative portal vein embolization (PVE) tailored to prepare the liver for complex and extended resections. During the past 5 years, 12 PVEs were performed in noncirrhotic patients with liver metastases from colon cancer (n = 10), choroidal melanoma (n = 1), and leiomyosarcoma (n = 1) to prepare complex anatomical liver resections in patients with small future remnant livers. These liver resections planned to preserve only segment IV in four patients, segments IV, V, and VIII in four patients, segments II, III, VI, and VII in three patients, and segments V and VI in one patient. PVE was performed under general anesthesia with a flow-guided injection of a mixture of cyanoacrylate and Lipiodol using a 5-Fr catheter. All portal branches feeding the liver segments to be resected were successfully embolized with cyanoacrylate except one, which was occluded with coils due to the risk of reflux with cyanoacrylate. After a mean of 32 days, CT volumetry revealed a mean hypertrophy of the unembolized liver of 47 {+-} 25% (range, 21-88%). Liver resections could be performed in 10 patients but were canceled in 2, due to the occurrence of a new hepatic tumor in one and an insufficiently increased volume in the other. Among the 10 patients who underwent the liver resection, 1 died of postoperative sepsis, 3 died 3 to 32 months after surgery, including 1 death unrelated to cancer, and 6 were alive after 6 to 36 months after surgery. In conclusion, in this preliminary report, PVE appears to be feasible and able to induce hypertrophy of the future remnant liver before a complex and extended hepatectomy. Further evaluation is needed in a larger cohort.

• OSTI ID: 21428927
• Journal Information: Cardiovascular and Interventional Radiology, Vol. 33, Issue 5; Other Information: DOI: 10.1007/s00270-009-9785-2; Copyright (c) 2010 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); ISSN 0174-1551
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ACRYLATES
EMBOLI
HEPATECTOMY
HYPERTROPHY
INJECTION
LARGE INTESTINE
LIPIODOL
LIVER
MELANOMAS
METASTASES
VEINS
BLOOD VESSELS
BODY
CARBOXYLIC ACID SALTS
CARCINOMAS
CARDIOVASCULAR SYSTEM
CONTRAST MEDIA
DIGESTIVE SYSTEM
DISEASES
EPITHELIOMAS
GASTROINTESTINAL TRACT
GLANDS
INTAKE
INTESTINES
MEDICINE
NEOPLASMS
OILS
ORGANIC COMPOUNDS
ORGANIC HALOGEN COMPOUNDS
ORGANIC IODINE COMPOUNDS
ORGANS
OTHER ORGANIC COMPOUNDS
PATHOLOGICAL CHANGES
SURGERY