title: Portal Vein Embolization in the Setting of Staged Hepatectomy with Preservation of Segment IV ± I Only for Bilobar Colorectal Liver Metastases: Safety, Efficacy, and Clinical Outcomes.
abstract: OBJECTIVE
  To assess frequency of adverse events, efficacy, and clinical outcomes of percutaneous portal vein embolization (PVE) in patients with bilobar colorectal liver metastases undergoing staged hepatectomy with preservation of segment IV ± I only.
  
  
  METHODS
  Retrospective analysis was performed of 40 consecutive patients who underwent right PVE after successful left lobectomy between 2005 and 2013. Rates of adverse events, future liver remnant (FLR) > 30% compared with baseline liver volume, clinical success (completion of staged hepatectomy with clearance of liver metastases), and overall survival were analyzed.
  
  
  RESULTS
  PVE was performed using polyvinyl alcohol particles (n = 7; 17.5%), particles plus coils (n = 23; 57.5%), and N-butyl cyanoacrylate glue plus ethiodized oil (n = 10; 25%). Technical success was 100%. After PVE, 20% (n = 8) of patients exhibited portal venous thrombosis, ranging from isolated intrahepatic portal branch thrombosis to massive thrombosis of the main portal vein (n = 3) and responsible for periportal cavernoma and portal hypertension in 5 patients. Of patients, 23 (57.5%) had FLR ≥ 30%, and 21 (52.5%) had clinical success. Six patients had significant stenosis or occlusion of the left portal vein or biliary system after original left lobectomy, which was independently associated with FLR < 30% (R2= 0.24). Clinical success was the only independent variable associated with survival (R2= 0.25).
  
  
  CONCLUSIONS
  PVE for staged hepatectomy with preservation of segment IV ± I only is technically feasible, leading to adequate hypertrophy and clinical success rates in these patients with poor oncologic prognosis. Portal venous thrombosis is greater after the procedure than in the setting of standard PVE.
authors.affiliation: Department of RadiologyRoyal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada; Departments of Diagnostic and Interventional Radiology, Pathology, Digestive Oncology, and Visceral Surgery, Hôpital Haut-Lévêque, University Hospital of Bordeaux, Pessac, France. Electronic address: Cassinotto@gmail.com.
authors.forename: Christophe
authors.initials: C
authors.lastname: Cassinotto
authors.affiliation: Department of RadiologyRoyal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Dohan
authors.affiliation: Department of RadiologyRoyal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada.
authors.forename: Benoît
authors.initials: B
authors.lastname: Gallix
authors.affiliation: Hepato-Pancreato-Biliary and Abdominal Organ Transplant Surgery (E.S., P.M.), Royal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada.
authors.forename: Eve
authors.initials: E
authors.lastname: Simoneau
authors.affiliation: Department of RadiologyRoyal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada.
authors.forename: Louis-Martin
authors.initials: LM
authors.lastname: Boucher
authors.affiliation: Hepato-Pancreato-Biliary and Abdominal Organ Transplant Surgery (E.S., P.M.), Royal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Metrakos
authors.affiliation: Department of RadiologyRoyal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Cabrera
authors.affiliation: Department of RadiologyRoyal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada.
authors.forename: Carlos
authors.initials: C
authors.lastname: Torres
authors.affiliation: Department of RadiologyRoyal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada.
authors.forename: Karl
authors.initials: K
authors.lastname: Muchantef
authors.affiliation: Department of RadiologyRoyal Victoria Hospital, McGill University Health Center, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Valenti
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011169:Portal Vein; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome