title: Portal vein embolization before extended hepatectomy for biliary cancer: current technique and review of 494 consecutive embolizations.
abstract: BACKGROUND
  Portal vein embolization (PVE) has been widely applied before extended hepatectomy; however, its clinical utility for patients with biliary cancer has not been fully addressed.
  
  
  METHODS
  Between 1991 and 2010, 494 patients with cholangiocarcinoma (n = 353) or gallbladder cancer (n = 141) underwent PVE before extended hepatectomy. PVE was performed by a transhepatic ipsilateral approach using fibrin glue or absolute ethanol with steel coils. Surgical outcomes of this cohort were retrospectively reviewed.
  
  
  RESULTS
  PVE-related complications requiring interventions were found in 3 (0.6%) of the 494 patients; no patient died of these complications. Among the 494 patients, 122 (24.7%) did not undergo subsequent hepatectomy. The unresectability rate was significantly higher in patients with gallbladder cancer than in those with cholangiocarcinoma [43.2% (61/141) and 17.3% (61/353), respectively, p < 0.001]. The remaining 372 patients underwent hepatectomy, and 24 (6.5%) died of postoperative complications [13 of 80 (16.3%) with gallbladder cancer vs. 11 of 292 (3.8%) with cholangiocarcinoma, p < 0.05]. The overall survival for patients with cholangiocarcinoma was significantly better than that for patients with gallbladder cancer, where the 5-year survival rate was 39 and 23%, respectively (p < 0.001). Thirty-six patients with cholangiocarcinoma and 10 patients with gallbladder cancer survived more than 5 years after extended surgery.
  
  
  CONCLUSIONS
  PVE can be performed safely in patients with cholestatic liver, and it has a potential benefit for patients with advanced biliary cancer who are to undergo extended, difficult hepatectomy.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Igami
authors.forename: Gen
authors.initials: G
authors.lastname: Sugawara
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000098:blood supply / Q000628:therapy*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000098:blood supply / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005706:Gallbladder Neoplasms / Q000098:blood supply / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D011300:Preoperative Care / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D000431:Ethanol