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. 2003 Aug;9(8):1702-6.
doi: 10.3748/wjg.v9.i8.1702.

Role of preoperative selective portal vein embolization in two-step curative hepatectomy for hepatocellular carcinoma

Wu Ji  1 , Jie-Shou Li, Ling-Tang Li, Wu-Hong Liu, Kuan-Sheng Ma, Xiang-Tian Wang, Zhen-Ping He, Jia-Hong Dong
Affiliations

Role of preoperative selective portal vein embolization in two-step curative hepatectomy for hepatocellular carcinoma

Wu Ji et al. World J Gastroenterol. 2003 Aug.

Abstract

Aim: To determine the feasibility and role of ultrasound-guided preoperative selective portal vein embolization (POSPVE) in the two-step hepatectomy of patients with advanced primary hepatocellular carcinoma (HCC).

Methods: Fifty patients with advanced HCC who were not suitable for curative hepatectomy were treated by ultrasound-guided percutaneous transhepatic POSPVE with fine needles. The successful rate, side effects and complications of POSPVE, changes of hepatic lobe volume and two-step curative hepatectomy rate after POSPVE were observed.

Results: POSPVE was successfully performed in 47 (94.0 %) patients. In patients whose right portal vein branches were embolized, their right hepatic volume decreased and left hepatic volume increased gradually. The ratio of right hepatic volume to total hepatic volume decreased from 62.4 % before POSPVE to 60.5 %, 57.2 % and 52.8 % after 1, 2 and 3 weeks respectively. The side effects included different degree of pain in liver area (38 cases), slight fever (27 cases), nausea and vomiting (9 cases). The level of aspartate alanine transaminase (AST), alanine transaminase (ALT) and total bilirubin (TBIL) increased after POSPVE, but returned to preoperative level in 1 week. After 2-4 weeks, two-step curative hepatectomy for HCC was successfully performed on 23 (52.3 %) patients. There were no such severe complications as ectopic embolization, local hemorrhage and bile leakage.

Conclusion: Ultrasound-guided percutaneous transhepatic POSPVE with fine needles is feasible and safe. It can extend the indications of curative hepatectomy of HCC, and increase the safety of hepatectomy.

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Figures

Figure 1
Figure 1
The fine needle was inserted into the right portal vein branch under ultrasound guidance. After embolization material was injected, tiny spot echoes appeared in the portal vein branch and diffused to the carcinoma area.
Figure 2
Figure 2
Before POSPVE, CT scan showed a 13.2 cm×10.8 cm HCC in the right lobe of liver. A right semihepatectomy was scheduled to perform.
Figure 3
Figure 3
Three weeks after right POSPVE, CT scan showed in-creased volume of left lobe and decreased volume of right lobe. Iodized oil deposit still could be seen in the right portal vein branch.
Figure 4
Figure 4
Three weeks after right POSPVE, a right semihepatectomy was performed. In the operation, significant hypertrophy of left lobe was confirmed.
Figure 5
Figure 5
In the same operation, significant atrophy of right lobe and HCC could be seen. There was iodized oil deposit in the carcinoma area.
See this image and copyright information in PMC

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