The role of the preoperative portal vein embolization in major hepatectomy

To assess the role of the preoperative portal vein embolization (PVE) in patients in need of major hepatectomy. Total of 11 cases consisted of Klatskin tumor (n = 6), gallbladder cancer (n = 2), and hepatocellular carcinoma (n = 3). After percutaneous transhepatic puncture of portal vein (right: 7, left: 4), the embolization of 1st order branch of right portal vein was done with Gentamicin soaked Gelfoam cubes. Radiologically, the angle between the middle hepatic vein and the inferior vena cava was measured on pre-and post-PVE CT (F/U: 10 days) to evaluate the hypertrophy of the left lobe. Clinically, amount and nature of the drained bile through the PTBD tube of both lobes were analyzed in 5 patients with Klatskin tumor. The interval between PVE and operation was 10-24 days. Operative findings and the changes of postop, total bilirubin were analyzed and the complication after procedure was checked. There was decrease in mean angle between the middle hepatic vein and the inferior vena cava from 35.9 degree to 23.9 degree, but it was insignificant statistically (ρ = 0.09). The embolization of right portal vein was done and there was increase in amount of drained bile from the nonembolized left lobe by 2-3 folds 8-14 days after PVE. The color and consistency between both lobes were significantly different; right lobe was darker in color and softer in consistency. Postoperative total bilirubin increased by 2-3 folds 1 to 4 days after PVE and normalized 10 to 14 days after PVE. Most of the patients had mild abdominal pain and fever after PVE and 1 patient had localized hematoma at puncture site which was subsided spontaneously. The preoperative portal vein embolization is a useful method for minimizing postoperative liver failure in patients in need of major hepatectomy