title: Arterial versus portal venous embolization for induction of hepatic hypertrophy before extended right hemihepatectomy in hilar cholangiocarcinomas: a prospective randomized study.
abstract: OBJECTIVE
  To assess the efficacy and safety of portal vein (PV) embolization versus hepatic artery embolization (HAE) for induction of hepatic hypertrophy before extended right hemihepatectomy in patients with hilar cholangiocarcinoma.
  
  
  METHODS
  Fifty patients (female, n = 15; male, n = 35; age range, 37-80 y) with hilar cholangiocarcinomas who were planned to undergo extended right hemihepatectomy were prospectively included in 2003-2006. In addition to biliary decompression of the left liver, patients were randomized to undergo embolization of the right hepatic artery (with transfemoral access and polyvinyl alcohol [PVA] particles plus coils) or right PV branches (with computed tomography [CT]-guided transhepatic access and PVA particles). CT was performed before and approximately 3 weeks after embolization for volumetric assessment of the liver.
  
  
  RESULTS
  In the HAE group, median growth of the left lateral segments was 40 mL (P < .01), with a median reduction of the whole liver of 10 mL (P = .41); adverse events were observed in two of 25 patients (8%), who each developed an abscess in the right liver lobe. In the PV embolization group, median growth of the left lateral segments was 110 mL (P < .01), with a median growth of the whole liver of 10 mL (P = .92); a subcapsular seroma occurred in one of 25 patients (4%). The median growth of the left lateral segments after PV embolization was significantly greater than after HAE (P = .004).
  
  
  CONCLUSIONS
  Compared with HAE, PV embolization was significantly superior regarding induction of hepatic hypertrophy of the left lateral segments.
authors.affiliation: Department of Radiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany. timm.denecke@charite.de
authors.forename: Timm
authors.initials: T
authors.lastname: Denecke
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.forename: Ingo G
authors.initials: IG
authors.lastname: Steffen
authors.forename: Christian
authors.initials: C
authors.lastname: Grieser
authors.forename: Lars
authors.initials: L
authors.lastname: Stelter
authors.forename: Dirk
authors.initials: D
authors.lastname: Schnapauff
authors.forename: Jan Holger
authors.initials: JH
authors.lastname: Rothe
authors.forename: Andreas
authors.initials: A
authors.lastname: Weigelt
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
authors.forename: Jan
authors.initials: J
authors.lastname: Langrehr
authors.forename: Pietr
authors.initials: P
authors.lastname: Podrabsky
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Enrique Lopez
authors.initials: EL
authors.lastname: Hänninen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D003664:Decompression; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005858:Germany; D006498:Hepatectomy; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011169:Portal Vein; D011172:Portography; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome