title: Preoperative portal vein embolization with a combination of trisacryl microspheres, gelfoam and coils.
abstract: OBJECTIVE
  To evaluate the safety and efficiency of preoperative portal vein embolization (PVE) with a combination of trisacryl microspheres, gelfoam and coils for inducing lobar hypertrophy in hepatobiliary malignancy patients.
  
  
  METHODS
  PVE was performed by a percutaneous left approach in 63 patients with hepatic malignancy (hepatocarcinoma=38, colorectal metastasis=14, cholangiocarcinoma=11). The indication of PVE and surgery was evaluated by hepatic tumor board take into consideration to the tumor extension and the hepatic volume on initial and post-embolization CT-scans. The total functional liver volume (TELV) and future liver remnant (FLR) volume were measured before and 24±5days after PVE to assess FLR, TELV and FLR/TELV ratios. Efficiency evaluation was based on FLR increase, the ability to perform the hepatectomy and the hepatic function after surgery. Safety evaluation was determined by clinical and biological follow-up after embolization and surgery.
  
  
  RESULTS
  PVE was successful in all the patients. The mean FLR volume increases by 57±56% after embolization (449±180cm(3) to 663±254cm(3)) (P<0.0001). The FLR/TELV ratio increases by 11% after PVE (25±8% to 36±12%). Three minors' complications were registered without impact on surgery, and four patients developed portal hypertension. Forty-nine patients underwent hepatectomy; none of them developed liver failure. Surgery was not performed in 14 patients due to tumor progression (n=9), inadequate hypertrophy of FLR (n=1) and portal hypertension (n=4).
  
  
  CONCLUSIONS
  Preoperative PVE with a combination of trisacryl microspheres, gelfoam and coils is a safe and effective method for inducing contralateral hypertrophy before right hepatectomy in patients with advanced hepatobiliary malignancy.
authors.affiliation: Radiology Department, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France. Electronic address: julien.cazejust@sat.aphp.fr.
authors.forename: J
authors.initials: J
authors.lastname: Cazejust
authors.affiliation: Radiology Department, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Bessoud
authors.affiliation: Radiology Department, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Le Bail
authors.affiliation: Radiology Department, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Menu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000098:blood supply / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005260:Female; D005781:Gelatin Sponge, Absorbable; D006490:Hemostatics; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011169:Portal Vein; D011300:Preoperative Care; D012189:Retrospective Studies
chemical_list: D006490:Hemostatics
keywords: Contralateral approach; Embolic agents; Liver tumor; Portal vein embolization