Effectiveness of preoperative percutaneous portal vein embolization in extending the indications of major hepatectomy

Purpose: We evaluate the effectiveness of percutaneous portal vein embolization (PPVE) in increasing the volume of the left hepatic lobe in order to allow safe right hepatectomy, reducing the risk of postoperative hepatic failure. Materials and methods: Percutaneous right portal embolization (with selective embolization of the IV segment in 8 cases) was performed in 14 patients (8 males and 6 females; mean age 61) in which the preoperative remaining liver volume (at Spiral CT volumetry) did not allow safe hepatectomy. 6 patients had metastases, 2 hepatocellular carcinoma (HCC) while 6 had hilar cholangiocarcinoma. A right portal vein approach was obtained in 12 patients while in 2 we performed a left approach. Complete embolization was achieved after selective catheterization with a 3 french coaxial system, injecting a mixture of Lipiodol and surgical glue. Results: In 10 patients (71.4%) an increased left liver volume (from 2.7% to 21.4%; mean 8.7%) was achieved during a mean time interval of 37 days (from 20 to 62 days) allowing surgical resection. In our series the best hypertrophy was obtained when embolization of the segment IV was performed. Surgery was not feasible in 4 patients (28.6%) with metastatic disease (2 patients), HCC (1 patient) and hilar cholangiocarcinoma (1 patient) due to poor clinical conditions. Conclusions: PPVE is a safe and feasible procedure that allows surgery in patients with an initial small liver volume. It can fail in patients whose clinical conditions deteriorate during the time interval necessary for hypertrophy. (authors)