Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma.
BACKGROUND
Percutaneous transhepatic embolization of the right portal vein plus the left medial portal branch (R3-PE) and the left portal vein plus the right anterior portal branch (L3-PE) is not well described.


METHODS
Four patients with far advanced carcinoma of the hepatic hilus underwent R3-PE (n = 1) or L3-PE (n = 3) as preoperative management for right hepatic trisegmentectomy or left hepatic trisegmentectomy. The portal vein embolization was performed with the ipsilateral approach through the right anterior portal branch.


RESULTS
In all patients the embolizations were successful without complications. Volumetric study with computed tomography showed sufficient hypertrophy of the nonembolized hepatic segments. Three of the four patients eventually underwent trisegmentectomy. The postoperative courses in two of the patients were uneventful. The remaining patient suffered from posthepatectomy liver failure but recovered.


CONCLUSIONS
R3-PE or L3-PE is advisable as preoperative management for trisegmentectomy and appears effective for increasing the safety of the operation. This embolization is achievable only through the ipsilateral approach.
Nagino
M
M
First Department of Surgery, Nagoya University School of Medicine, Japan.
Nimura
Y
Y
Kamiya
J
J
Kondo
S
S
Uesaka
K
K
Kin
Y
Y
Kutsuna
Y
Y
Hayakawa
N
N
Yamamoto
H
H
D000328:Adult; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D017114:Liver Failure, Acute / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011172:Portography; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed