title: Combination of preoperative embolization of the right portal vein and hepatic artery prior to major hepatectomy in high-risk patients: a preliminary report.
abstract: OBJECTIVE
  Preoperative transhepatic portal vein embolization may not always be sufficient to achieve the desired changes in contralateral hepatic volume and function. The beneficial role of additional transcatheter arterial embolization performed after inadequate response to preoperative transhepatic portal vein embolization is described.
  
  
  METHODS
  Four patients underwent both preoperative transhepatic portal vein embolization and transcatheter arterial embolization, and 6 control patients underwent preoperative transhepatic portal vein embolization only. Changes in right liver lobe volume fraction, residual left lobe volume fraction, and prediction score (low-risk, < 45; borderline, 45-55; high-risk > 55); were evaluated.
  
  
  RESULTS
  1) The change in right liver lobe volume after both preoperative transhepatic portal vein embolization and transcatheter arterial embolization (volume after/before) was 0.75 times that of the original level whereas after preoperative transhepatic portal vein embolization, they were only 0.81 times that of the original level. 2) The change in residual left liver volume after both preoperative transhepatic portal vein embolization and transcatheter arterial embolization (volume after/before) was 1.40 times that of the original level whereas after preoperative transhepatic portal vein embolization they were only 1.30 times than the original level. The changes in left liver volume after preoperative transhepatic portal vein embolization/transcatheter arterial embolization was more favorable than those after preoperative transhepatic portal vein embolization only. 3) The change in prediction score after both preoperative transhepatic portal vein embolization and transcatheter arterial embolization (after/before) was 0.81 times that of the original level. All prediction score in high-risk patients recovered to the borderline or safety zone. Change after preoperative transhepatic portal vein embolization only (before/after) was 0.87 times that of the original level. 4) All 4 patients who underwent both preoperative transhepatic portal vein embolization and transcatheter arterial embolization received right hepatic lobectomy successfully and returned to their normal life style.
  
  
  CONCLUSIONS
  Preoperative occlusion of right hepatic inflow vessels increased the volume and function of the contralateral lobe where high-risk patients recovered to the borderline zone for major hepatic resection.
authors.affiliation: First Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Inaba
authors.forename: T
authors.initials: T
authors.lastname: Takada
authors.forename: H
authors.initials: H
authors.lastname: Amano
authors.forename: M
authors.initials: M
authors.lastname: Yoshida
authors.forename: Y
authors.initials: Y
authors.lastname: Yamakawa
authors.forename: H
authors.initials: H
authors.lastname: Yasuda
authors.forename: Y
authors.initials: Y
authors.lastname: Takada
authors.forename: K
authors.initials: K
authors.lastname: Takeshita
authors.forename: H
authors.initials: H
authors.lastname: Koutake
authors.forename: K
authors.initials: K
authors.lastname: Takada
authors.forename: S
authors.initials: S
authors.lastname: Furui
authors.forename: H
authors.initials: H
authors.lastname: Hijikata
authors.forename: K
authors.initials: K
authors.lastname: Takada
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000628:therapy*; D016022:Case-Control Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006498:Hepatectomy; D006503:Hepatic Veins; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011300:Preoperative Care; D012307:Risk Factors; D016896:Treatment Outcome