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CardioVascular and Interventional Radiology

, Volume 41, Issue 9, pp 1302–1312 | Cite as

Portal Vein Embolization Utilizing N-Butyl Cyanoacrylate for Contralateral Lobe Hypertrophy Prior to Liver Resection: A Systematic Review and Meta-Analysis

  • Ethan Wajswol
  • Tarek Jazmati
  • Sohail Contractor
  • Abhishek KumarEmail author
Review

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.

Keywords

Portal vein embolization Future liver remnant (FLR) Relative hypertrophy rate n-Butyl cyanoacrylate (NBCA) 

Notes

Authors’ Contribution

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.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and Animals Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    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.CrossRefGoogle Scholar
  7. 7.
    Barbaro B, Caputo F, Tebala C, et al. Preoperative right portal vein embolisation: indications and results. Radiol Med (Torino). 2009;114(4):553–70.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefGoogle Scholar
  10. 10.
    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.CrossRefGoogle Scholar
  11. 11.
    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.CrossRefGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    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.PubMedGoogle Scholar
  18. 18.
    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.Google Scholar
  19. 19.
    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.Google Scholar
  20. 20.
    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.PubMedGoogle Scholar
  21. 21.
    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.PubMedGoogle Scholar
  22. 22.
    Sirichindakul B, Nonthasoot B, Taesombat W, et al. Role of portal vein embolization in hepatobiliary malignancy. Hepatogastroenterology. 2007;54(80):2297–300.PubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar
  25. 25.
    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.Google Scholar
  26. 26.
    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.PubMedPubMedCentralGoogle Scholar
  27. 27.
    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.CrossRefPubMedGoogle Scholar
  28. 28.
    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.CrossRefGoogle Scholar
  29. 29.
    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.CrossRefPubMedGoogle Scholar
  30. 30.
    Vinters HV, Galil KA, Lundie MJ, Kaufmann JC. The histotoxicity of cyanoacrylates. A selective review. Neuroradiology. 1985;27(4):279–91.CrossRefPubMedGoogle Scholar
  31. 31.
    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.PubMedGoogle Scholar
  32. 32.
    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.PubMedGoogle Scholar
  33. 33.
    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.CrossRefPubMedGoogle Scholar
  34. 34.
    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.CrossRefPubMedGoogle Scholar
  35. 35.
    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.CrossRefPubMedGoogle Scholar
  36. 36.
    Abdalla EK, Hicks ME, Vauthey JN. Portal vein embolization: rationale, technique and future prospects. Br J Surg. 2001;88(2):165–75.CrossRefPubMedGoogle Scholar
  37. 37.
    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.CrossRefGoogle Scholar
  38. 38.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Rutgers New Jersey Medical SchoolNewarkUSA
  2. 2.Department of Radiology, New Jersey Medical SchoolRutgers UniversityNewarkUSA

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