Abstract
Purpose
To evaluate the safety and effectiveness of n-butyl cyanoacrylate (NBCA) for portal vein embolization (PVE) when used to induce contralateral future liver remnant (FLR) hypertrophy in patients undergoing planned hepatic resection for hepatic malignancy.
Materials and Methods
The PubMed database (including articles indexed by MEDLINE) was searched for articles published from 1970 to 2018 describing patients treated with PVE utilizing NBCA to induce hypertrophy of the FLR prior to contralateral hepatic lobe resection. Demographic data, embolization technique, complications of embolization, resultant FLR hypertrophy, and surgical outcomes were obtained when available. A meta-analysis was performed to determine the cumulative relative hypertrophy rate of the FLR following PVE with NBCA.
Results
The literature search yielded 18 relevant articles. Six hundred and seven patients (383 men, 220 women; mean age 60.7 years) with procedures describing PVE utilizing NBCA were reviewed. The most common underlying hepatic malignancies were colorectal metastases (n = 348), followed by cholangiocarcinomas (n = 92), and hepatocellular carcinomas (n = 89). Technical success was reportedly achieved in 603/607 patients, for a success rate of 99.3%. Fixed effects meta-analysis of the relative hypertrophy rate of the FLR among studies resulted in an aggregate rate of 49.4 ± 1.3%. Of the patients who underwent attempted PVE, 461/607 (75.9%) eventually underwent surgical resection. Major complications following PVE occurred in 19 patients (3.13%), while minor complications following PVE occurred in 38 patients (6.26%).
Conclusions
PVE utilizing NBCA to induce hypertrophy of the FLR prior to contralateral lobe resection in the setting of hepatic malignancy is safe and effective.
Level of Evidence
Level IIa—Systematic review of cohort studies.
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Change history
13 August 2018
The following publication was cited in the published article, but it was not included in the reference list.
References
Abdalla EK, Adam R, Bilchik AJ, Jaeck D, Vauthey JN, Mahvi D. Improving resectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol. 2006;13(10):1271–80.
Azoulay D, Castaing D, Krissat J, et al. Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver. Ann Surg. 2000;232(5):665–72.
de Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V. Preoperative portal vein embolization for extension of hepatectomy indications. Hepatology (Baltimore, MD). 1996;24(6):1386–91.
Abulkhir A, Limongelli P, Healey AJ, et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg. 2008;247(1):49–57.
van Lienden KP, van den Esschert JW, de Graaf W, et al. Portal vein embolization before liver resection: a systematic review. Cardiovasc Interv Radiol. 2013;36(1):25–34.
Denys A, Bize P, Demartines N, Deschamps F, De Baere T. Quality improvement for portal vein embolization. Cardiovasc Interv Radiol. 2010;33(3):452–6.
Barbaro B, Caputo F, Tebala C, et al. Preoperative right portal vein embolisation: indications and results. Radiol Med (Torino). 2009;114(4):553–70.
Bellemann N, Stampfl U, Sommer CM, Kauczor HU, Schemmer P, Radeleff BA. Portal vein embolization using a histoacryl/lipiodol mixture before right liver resection. Dig Surg. 2012;29(3):236–42.
Bent CL, Low D, Matson MB, Renfrew I, Fotheringham T. Portal vein embolization using a nitinol plug (Amplatzer vascular plug) in combination with histoacryl glue and iodinized oil: adequate hypertrophy with a reduced risk of nontarget embolization. Cardiovasc Interv Radiol. 2009;32(3):471–7.
Broering DC, Hillert C, Krupski G, et al. Portal vein embolization versus portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2002;6(6):905–13 ; discussion 913.
Capussotti L, Muratore A, Baracchi F, et al. Portal vein ligation as an efficient method of increasing the future liver remnant volume in the surgical treatment of colorectal metastases. Archiv Surg (Chicago, Ill: 1960). 2008;143(10):978–82 ; discussion 982.
de Baere T, Teriitehau C, Deschamps F, et al. Predictive factors for hypertrophy of the future remnant liver after selective portal vein embolization. Ann Surg Oncol. 2010;17(8):2081–9.
Denys A, Lacombe C, Schneider F, et al. Portal vein embolization with N-butyl cyanoacrylate before partial hepatectomy in patients with hepatocellular carcinoma and underlying cirrhosis or advanced fibrosis. J Vasc Interv Radiol JVIR. 2005;16(12):1667–74.
Giraudo G, Greget M, Oussoultzoglou E, Rosso E, Bachellier P, Jaeck D. Preoperative contralateral portal vein embolization before major hepatic resection is a safe and efficient procedure: a large single institution experience. Surgery. 2008;143(4):476–82.
Guiu B, Bize P, Gunthern D, Demartines N, Halkic N, Denys A. Portal vein embolization before right hepatectomy: improved results using n-butyl-cyanoacrylate compared to microparticles plus coils. Cardiovasc Interv Radiol. 2013;36(5):1306–12.
Jaberi A, Toor SS, Rajan DK, et al. Comparison of clinical outcomes following glue versus polyvinyl alcohol portal vein embolization for hypertrophy of the future liver remnant prior to right hepatectomy. J Vasc Interv Radiol JVIR. 2016;27(12):1897.e1891–1905.e1891.
Kaneko T, Nakao A, Takagi H. Clinical studies of new material for portal vein embolization: comparison of embolic effect with different agents. Hepatogastroenterology. 2002;49(44):472–7.
Kim GC, Bae JH, Ryeom HK. Percutaneous preoperative portal vein embolization using a combination of gelatin sponge and histoacryl glue. Acta Radiol (Stockholm, Sweden: 1987). 2009;50(10):1119–25.
Lindner P, Cahlin C, Friman S, et al. Extended right-sided liver resection for colorectal liver metastases–impact of percutaneous portal venous embolisation. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2006;32(3):292–6.
Perarnau JM, Daradkeh S, Johann M, Deneuville M, Weinling P, Coniel C. Transjugular preoperative portal embolization (TJPE) a pilot study. Hepatogastroenterology. 2003;50(51):610–3.
Peregrin JH, Janousek R, Kautznerova D, et al. A comparison of portal vein embolization with poly(2-hydroxyethylmethacrylate) and a histoacryl/lipiodol mixture in patients scheduled for extended right hepatectomy. Physiol Res. 2015;64(6):841–8.
Sirichindakul B, Nonthasoot B, Taesombat W, et al. Role of portal vein embolization in hepatobiliary malignancy. Hepatogastroenterology. 2007;54(80):2297–300.
Denys AL, Abehsera M, Sauvanet A, Sibert A, Belghiti J, Menu Y. Failure of right portal vein ligation to induce left lobe hypertrophy due to intrahepatic portoportal collaterals: successful treatment with portal vein embolization. AJR Am J Roentgenol. 1999;173(3):633–5.
Angle JF, Siddiqi NH, Wallace MJ, et al. Quality improvement guidelines for percutaneous transcatheter embolization: society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol JVIR. 2010;21(10):1479–86.
Makuuchi M, Takayasu K, Takuma T, et al. Preoperative transcatheter embolization of the portal venous branch for patients receiving extended lobectomy due to the bile duct carcinoma. J Jpn Pract Surg Soc. 1984;45(12):1558–64.
Loffroy R, Favelier S, Chevallier O, et al. Preoperative portal vein embolization in liver cancer: indications, techniques and outcomes. Quant Imaging Med Surg. 2015;5(5):730–9.
van den Esschert JW, van Lienden KP, Alles LK, et al. Liver regeneration after portal vein embolization using absorbable and permanent embolization materials in a rabbit model. Ann Surg. 2012;255(2):311–8.
Tsoumakidou G, Theocharis S, Ptohis N, et al. Liver hypertrophy after percutaneous portal vein embolization: comparison of N-butyl-2-cyanocrylate versus sodium acrylate-vinyl alcohol copolymer particles in a swine model. Cardiovasc Interv Radiol. 2011;34(5):1042–9.
de Baere T, Denys A, Paradis V. Comparison of four embolic materials for portal vein embolization: experimental study in pigs. Eur Radiol. 2009;19(6):1435–42.
Vinters HV, Galil KA, Lundie MJ, Kaufmann JC. The histotoxicity of cyanoacrylates. A selective review. Neuroradiology. 1985;27(4):279–91.
Kish KK, Rapp SM, Wilner HI, Wolfe D, Thomas LM, Barr J. Histopathologic effects of transarterial bucrylate occlusion of intracerebral arteries in mongrel dogs. AJNR Am J Neuroradiol. 1983;4(3):385–7.
Levrier O, Mekkaoui C, Rolland PH, et al. Efficacy and low vascular toxicity of embolization with radical versus anionic polymerization of n-butyl-2-cyanoacrylate (NBCA). An experimental study in the swine. J Neuroradiol. 2003;30(2):95–102.
Koga M, Ogasawara H. Induction of hepatocyte mitosis in intact adult rat by interleukin-1 alpha and interleukin-6. Life Sci. 1991;49(17):1263–70.
Feingold KR, Soued M, Grunfeld C. Tumor necrosis factor stimulates DNA synthesis in the liver of intact rats. Biochem Biophys Res Commun. 1988;153(2):576–82.
de Baere T, Roche A, Vavasseur D, et al. Portal vein embolization: utility for inducing left hepatic lobe hypertrophy before surgery. Radiology. 1993;188(1):73–7.
Abdalla EK, Hicks ME, Vauthey JN. Portal vein embolization: rationale, technique and future prospects. Br J Surg. 2001;88(2):165–75.
Imamura H, Shimada R, Kubota M, et al. Preoperative portal vein embolization: an audit of 84 patients. Hepatology (Baltimore, MD). 1999;29(4):1099–105.
Di Stefano DR, de Baere T, Denys A, et al. Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients. Radiology. 2005;234(2):625–30.
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Ethan Wajswol, B.S, Tarek Jazmati, MD, Sohail Contractor, MD, Abhishek Kumar, MD, helped in acquisition of data, analysis and interpretation, draft of the manuscript, critical revision of the manuscript for important intellectual content.
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Wajswol, E., Jazmati, T., Contractor, S. et al. Portal Vein Embolization Utilizing N-Butyl Cyanoacrylate for Contralateral Lobe Hypertrophy Prior to Liver Resection: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 41, 1302–1312 (2018). https://doi.org/10.1007/s00270-018-1964-6
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DOI: https://doi.org/10.1007/s00270-018-1964-6