Role of preoperative selective portal vein embolization in two-step curative hepatectomy for hepatocellular carcinoma.
OBJECTIVE
To determine the feasibility and role of ultrasound-guided preoperative selective portal vein embolization (POSPVE) in the two-step hepatectomy of patients with advanced primary hepatocellular carcinoma (HCC).


METHODS
Fifty patients with advanced HCC who were not suitable for curative hepatectomy were treated by ultrasound-guided percutaneous transhepatic POSPVE with fine needles. The successful rate, side effects and complications of POSPVE, changes of hepatic lobe volume and two-step curative hepatectomy rate after POSPVE were observed.


RESULTS
POSPVE was successfully performed in 47 (94.0 %) patients. In patients whose right portal vein branches were embolized, their right hepatic volume decreased and left hepatic volume increased gradually. The ratio of right hepatic volume to total hepatic volume decreased from 62.4 % before POSPVE to 60.5 %, 57.2 % and 52.8 % after 1, 2 and 3 weeks respectively. The side effects included different degree of pain in liver area (38 cases), slight fever (27 cases), nausea and vomiting (9 cases). The level of aspartate alanine transaminase (AST), alanine transaminase (ALT) and total bilirubin (TBIL) increased after POSPVE, but returned to preoperative level in 1 week. After 2-4 weeks, two-step curative hepatectomy for HCC was successfully performed on 23 (52.3 %) patients. There were no such severe complications as ectopic embolization, local hemorrhage and bile leakage.


CONCLUSIONS
Ultrasound-guided percutaneous transhepatic POSPVE with fine needles is feasible and safe. It can extend the indications of curative hepatectomy of HCC, and increase the safety of hepatectomy.
Ji
Wu
W
Institute of General Surgery, Nanjing General Hospital of Nanjing PLA Command Area, Nanjing 210002, Jiangsu Province, China. jiwusky@sohu.com
Li
Jie-Shou
JS
Li
Ling-Tang
LT
Liu
Wu-Hong
WH
Ma
Kuan-Sheng
KS
Wang
Xiang-Tian
XT
He
Zhen-Ping
ZP
Dong
Jia-Hong
JH
D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011169:Portal Vein; D011300:Preoperative Care; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography