Preoperative right portal vein embolisation: indications and results.
OBJECTIVE
The purpose of this retrospective study was to evaluate the efficacy of right portal vein embolisation (PVE) in inducing contralateral liver hypertrophy before extended hepatectomy.


METHODS
Twenty-six consecutive patients, 14 with liver metastases (ten from colorectal cancer; four from carcinoid tumours) and 12 with biliary cancers (ten Klatskin tumours; one gallbladder tumour; one intrahepatic cholangiocarcinoma) with insufficient predicted future remnant liver (FRL) underwent right PVE to induce hypertrophy of the contralateral hemiliver prior to surgical resection. Total liver volume, tumour volume and FRL volume were calculated on a 3D workstation. The ratio of the FRL to the total functional liver volume was <30% in all patients.


RESULTS
The FRL volume increased by 5%-25% (15% on average) after right PVE in patients with liver metastases and by 9%-19% (14% on average) in patients with biliary cancers. In all patients, the ratio of FRL to functional liver volume was >or=30% after right PVE. No postoperative deaths due to severe liver failure occurred in the 20 patients who underwent extended hepatectomy.


CONCLUSIONS
Right PVE extends the indications for hepatectomy in patients with liver metastases and those with biliary cancers who have an insufficient potential hepatic functional reserve.
Department of Bioimaging and Radiological Sciences, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo Agostino Gemelli 8, 00168, Rome, Italy. bbarbaro@rm.unicatt.it
B
B
Barbaro
F
F
Caputo
C
C
Tebala
C
C
Di Stasi
M
M
Vellone
F
F
Giuliante
G
G
Nuzzo
L
L
Bonomo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000188:drug therapy / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D001661:Biliary Tract Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000188:drug therapy / Q000601:surgery; D004621:Embolization, Therapeutic; D005260:Female; D005706:Gallbladder Neoplasms / Q000188:drug therapy / Q000601:surgery; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D018285:Klatskin Tumor / Q000188:drug therapy / Q000601:surgery; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome