title: Efficient liver regeneration following temporary portal vein embolization with absorbable gelatin sponge powder in humans.
abstract: OBJECTIVE
  To report initial experience of temporary portal vein embolization (PVE) with a powdered form of absorbable gelatin sponge before major liver resection.
  
  
  METHODS
  From 2009-2013, 20 patients (6 women and 14 men; median age, 61.5 y ± 2.8; range, 49-80 y) considered for major liver resections for both primary and secondary hepatic malignancies underwent temporary PVE. Data were retrospectively reviewed. Embolization of selected portal vein segments was performed using the powdered form of an absorbable gelatin sponge. All patients underwent volumetric computed tomography (CT) assessment before and at 4-6 weeks after PVE. Liver histology was normal in 13 patients; 1 patient had steatosis, and 6 patients had cirrhosis.
  
  
  RESULTS
  Subsegmental, segmental, and sectorial embolization was successfully performed in all patients. None of the patients developed liver insufficiency or fever after embolization. Volumetric CT assessment showed the disappearance of all portal thrombosis in 14 patients. The median hypertrophy ratio of the nonembolized liver was 29.4% ± 6.9 (range, 3.3-127.2%). Of 20 patients, 15 underwent surgery 1-2 months after temporary PVE. One (6.7%) patient presented with liver decompensation in the postoperative period. Five patients were not eligible for surgery because of tumor progression. Histologic examination of the resected liver revealed the presence of absorbable gelatin sponge powder in a few distal portal tracts in four patients. No residual absorbable gelatin sponge powder was observed in portal vessels in the remaining 11 patients.
  
  
  CONCLUSIONS
  Temporary PVE resulted in sufficient hypertrophy of the liver that did not receive embolization to enable surgical planning in all patients in our series.
authors: Department of Minimally Invasive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, Clamart F-92140, France; Paris-Sud University, Orsay, France.. Electronic address: hadrien.tranchart@abc.aphp.fr.
authors: Hadrien
authors: H
authors: Tranchart
authors: Department of Radiology, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, Clamart F-92140, France; Paris-Sud University, Orsay, France.
authors: Laurence
authors: L
authors: Catherine
authors: Department of Radiology, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, Clamart F-92140, France; Paris-Sud University, Orsay, France.
authors: Sophie
authors: S
authors: Maitre
authors: Department of Minimally Invasive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, Clamart F-92140, France; Paris-Sud University, Orsay, France.
authors: Panagiotis
authors: P
authors: Lainas
authors: Department of Radiology, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, Clamart F-92140, France; Paris-Sud University, Orsay, France.
authors: Jocelyne
authors: J
authors: De Laveaucoupet
authors: Department of Minimally Invasive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, Clamart F-92140, France; Paris-Sud University, Orsay, France.
authors: Ibrahim
authors: I
authors: Dagher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008115:Liver Regeneration / Q000187:drug effects / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000187:drug effects*; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D006490:Hemostatics