Preoperative portal embolization.
Excess parenchymal loss associated with hepatectomy is the leading risk factor/for liver failure especially in patients with impaired hepatic function. Selective portal embolization (PE) before hepatectomy is aimed to induce an atrophy of the embolized lobe to be resected, with a compensatory hypertrophy of the/counterlobe to be preserved. We performed PE followed by hepatectomy in 58 patients with hepatocellular carcinoma (HCC, n. = 44) or metastatic liver tumour (MLT, n. = 14). All the patients well tolerated PE, and hepatic functional data returned to the baseline levels within a week. The left lobe volume increased by about 10% after the right PE. Hepatectomy procedures undertaken comprised right or extended right lobectomy (n. = 39), central bisegmentectomy (n. = 3), extended segmentectomy (n. = 12), and limited resection (n. = 4). The 25 of HCC patients underwent right-sided lobectomy despite a presence of hepatic functional impairment, and the 3 of MLT patients under went right lobectomy with additional resection of the left lobe. As a whole, the operative morbidity and mortality rates were 15.5% and 1.7%, respectively (one patient died of liver failure). The 5-year over all survival rates were 46.8% in HCC patients and 38.0% in MLT patients, respectively. Preoperative PE therefore can be an ancillary procedure for patients, despite with hepatic dysfunction or with bilobar tumours, who may need extensive hepatectomy.
Takayama
T
T
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Makuuchi
M
M
Kosuge
T
T
Yamamoto
J
J
Shimada
K
K
Inoue
K
K
D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography