Trans-ileocecal portal vein embolization as a preoperative treatment for right trisegmentectomy with caudate lobectomy.
OBJECTIVE
The indication of preoperative portal vein embolization (PVE) has been expanded to hepatocellular carcinoma, cholangiocellular carcinoma (CCC), hepatic metastasis, and gallbladder (GB) cancer as well as hilar cholangiocarcinoma (hCC). However, biliary cancers sometimes cause peritoneal dissemination.


METHODS
We performed our preoperative trans-ileocecal-vein PVE (TIPE) method on 14 (3 GB cancer, 1 CCC, and 10 hCC), whose estimated residual liver volume was <30%.


RESULTS
Out of 14 patients, peritoneal dissemination was encountered in two patients with GB cancer and one with hCC (21.4%) during our procedure. The estimated residual liver volume was 37.4 +/- 2.7% at 14 days after PVE in patients without predisposing cholangitis, while those in patients with cholangitis was 29.3 +/- 1.3% (P = 0.0002). No major complication due to the procedure was encountered in this series.


CONCLUSIONS
PTPE could be the first choice for patients with hCC, hepatocellular carcinoma, and hepatic metastases. Although the TIPE proposed here has some potential disadvantages, we would recommend it especially for patients with GB cancer because of its high potential to cause cancerous peritonitis. When a patient had predisposing cholangitis, radical operation should be scheduled on >21 days after PVE rather than on 14 days.
Shimura
Tatsuo
T
Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. tshimura@showa.gunma-u.ac.jp
Suehiro
Taketoshi
T
Suzuki
Hideki
H
Okada
Kohji
K
Araki
Kenichiro
K
Kuwano
Hiroyuki
H
D001650:Bile Duct Neoplasms / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D002761:Cholangitis / Q000601:surgery; D004621:Embolization, Therapeutic; D005706:Gallbladder Neoplasms / Q000601:surgery; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D011169:Portal Vein; D011300:Preoperative Care