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. 2008 Nov;144(5):744-51.
doi: 10.1016/j.surg.2008.05.015. Epub 2008 Aug 10.

Is embolization of segment 4 portal veins before extended right hepatectomy justified?

Yoji Kishi  1 , David C Madoff, Eddie K Abdalla, Martin Palavecino, Dario Ribero, Yun Shin Chun, Jean-Nicolas Vauthey
Affiliations

Is embolization of segment 4 portal veins before extended right hepatectomy justified?

Yoji Kishi et al. Surgery. 2008 Nov.

Abstract

Background: Preoperative portal vein embolization (PVE) is increasingly used as a preparation for major hepatectomy in patients with inadequate liver remnant volume or function. However, whether segment 4 (S4) portal veins should be embolized is controversial. The effect of S4 PVE on the volume gain of segments 2 and 3 (S2+3) was examined.

Methods: Among 73 patients with uninjured liver who underwent right portal vein embolization (RPVE, n = 15) or RPVE extended to S4 portal veins (RPVE+4, n = 58), volume changes in S2+3 and S4 after embolization were compared. Clinical outcomes and PVE complications were assessed.

Results: After a median of 27 days, the S2+3 volume increased significantly after both RPVE and RPVE+4, but the absolute increase was significantly higher for RPVE+4 (median, 106 mL vs 141 mL; P = .044), as was the hypertrophy rate (median, 26% vs 54%; P = .021). There was no significant difference between RPVE and RPVE+4 in the absolute S4 volume increase (52 mL for RPVE vs 55 mL for RPVE+4; P = .61) or the hypertrophy rate of S4 (30% for RPVE vs 26% for RPVE+4; P = .45). Complications of PVE occurred in 1 patient (7%) after RPVE and 6 (10%) after RPVE+4 (P > .99). No PVE complication precluded subsequent resection. Curative hepatectomy was performed in 13 patients (87%) after RPVE and 40 (69%) after RPVE+4 (P = .21).

Conclusions: RPVE+4 significantly improves S2+3 hypertrophy compared with RPVE alone. Extending RPVE to S4 does not increase PVE-associated complications.

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Figures

Fig 1
Fig 1
Flow chart of the selection of patients for this study. TACE, transcatheter arterial chemoembolization; Hx, hepatectomy.
Fig 2
Fig 2
Portography after RPVE+4. White arrows, coils used to embolize S4 portal vein branches; black arrows, coils used to embolize right portal vein branches.
Fig 3
Fig 3
CT image after RPVE+4. Note that major S4 branches, in addition to right portal vein branches, were distally embolized (white arrow). Black arrows, coils used to embolized right portal vein branches. Black arrowhead, tumor
Fig 4
Fig 4
Changes in S2+3 volume (a) and S4 volume (b) in each patient as a result of RPVE or RPVE+4.
Fig 4
Fig 4
Changes in S2+3 volume (a) and S4 volume (b) in each patient as a result of RPVE or RPVE+4.
See this image and copyright information in PMC

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