title: Preoperative selective portal vein embolization (PSPVE) before major hepatic resection. Effectiveness of Doppler estimation of hepatic blood flow to predict the hypertrophy rate of non-embolized liver segments.
abstract: Hepatocellular carcinoma may be unresectable for volumetric reasons. The future remaining liver after hepatectomy might be too small to ensure survival. Preoperative selective portal vein embolization of the tumorous lobe can induce hypertrophy of the future remaining liver and enable safer surgery. A 76-year-old patient with hepatocellular carcinoma needed right lobectomy however, the future remaining liver was judged insufficient to ensure an uneventful postoperative course. The left lobe to whole liver volumetric ratio was to small (29.7%) and a preoperative selective portal vein embolization of the right portal branch via a percutaneous, transhepatic, contralateral approach was performed without side effects. A Doppler estimation of left branch portal blood flow and velocity was carried out before and after preoperative selective portal vein embolization. After 21 days the left lobe volume increased by about 44.2% with a safe left lobe/whole liver ratio of 40.8%. The portal blood flow and portal blood flow velocity showed an increase of 253% and 122%, respectively. A right lobectomy was performed without complications. Three months later, computed tomography scan showed no hepatocellular carcinoma recurrence. Preoperative selective portal vein embolization is a safe technique which can enable major hepatectomy to be performed in situations otherwise judged unresectable for a life-threatening volumetric insufficiency. The portal blood flow and portal blood flow velocity evaluations can easily predict the hypertrophy rate of non-embolized liver segments.
authors.affiliation: Third Clinic of Surgery, Padova University, Italy. giorgio.gerunda@unipd.it
authors.forename: Giorgio Enrico
authors.initials: GE
authors.lastname: Gerunda
authors.forename: Massimo
authors.initials: M
authors.lastname: Bolognesi
authors.forename: Daniele
authors.initials: D
authors.lastname: Neri
authors.forename: Roberto
authors.initials: R
authors.lastname: Merenda
authors.forename: Diego
authors.initials: D
authors.lastname: Miotto
authors.forename: Franco
authors.initials: F
authors.lastname: Barbazza
authors.forename: Fabio
authors.initials: F
authors.lastname: Zangrandi
authors.forename: Marco
authors.initials: M
authors.lastname: Bisello
authors.forename: Michele
authors.initials: M
authors.lastname: Valmasoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Gangemi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gagliesi
authors.forename: Alvise Maffei
authors.initials: AM
authors.lastname: Faccioli
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic; D006499:Hepatic Artery / Q000503:physiopathology; D006801:Humans; D006984:Hypertrophy; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D011169:Portal Vein / Q000503:physiopathology; D011300:Preoperative Care; D012039:Regional Blood Flow; D018616:Ultrasonography, Doppler, Duplex; D014655:Vascular Resistance