Portal vein embolization before right hepatectomy: improved results using n-butyl-cyanoacrylate compared to microparticles plus coils.
BACKGROUND
There is currently no consensus in the literature on which embolic agent induces the greatest degree of liver hypertrophy after portal vein embolization (PVE). Only experimental results in a pig model have demonstrated an advantage of n-butyl-cyanoacrylate (NBCA) over 3 other embolic materials (hydrophilic gel, small and large polyvinyl alcohol particles) for PVE. Therefore, the aim of this human study was to retrospectively compare the results of PVE using NBCA with those using spherical microparticles plus coils.


METHODS
A total of 34 patients underwent PVE using either NBCA (n = 20), or spherical microparticles plus coils (n = 14). PVE was decided according to preoperative volumetry on the basis of contrast-enhanced CT. Groups were compared for age, sex, volume of the left lobe before PVE and future remnant liver ratio (FRL) (volume of the left lobe/total liver volume - tumor volume). The primary end point was the increase in left lobe volume 1 month after PVE. Secondary end points were procedure complications and biological tolerance.


RESULTS
Both groups were similar in terms of age, sex ratio, left lobe volume, and FRL before PVE. NBCA induced a greater increase in volume after PVE than did microparticles plus coils (respectively, +74 ± 69 % and +23 ± 14 %, p < 0.05). The amount of contrast medium used for the procedure was significantly larger when microparticles and coils rather than NBCA were used (respectively, 264 ± 43 ml and 162 ± 34 ml, p < 0.01). The rate of PVE complications as well as the biological tolerance was similar in both groups.


CONCLUSIONS
NBCA seems more effective than spherical microparticles plus coils to induce left-lobe hypertrophy.
Digestive & Oncologic Imaging and Interventional Radiology Unit, Department of Radiology and Interventional Radiology, Centre Hospitalo-Univeristaire Vaudois, Rue du Bugnon 46, 1011, Lausanne, Switzerland, boris.guiu@chu-dijon.fr.
Boris
B
Guiu
Pierre
P
Bize
Daniel
D
Gunthern
Nicolas
N
Demartines
Nermin
N
Halkic
Alban
A
Denys
D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000187:drug effects*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D004659:Enbucrilate