Abstract
The objective of this study was to assess the efficacy of right portal vein embolization (PVE) vs. right portal vein ligation (PVL) for induction of hypertrophy of the left lateral liver lobe before extended right hepatectomy. Thirty-four patients with primary or secondary liver tumors and estimated remnant functional liver parenchyma of less than 0.5% of body weight underwent either right PVE (transcutaneous, n= 10; transileocolic, n =7) or right PVL (n=17). Liver volume was assessed by CT scan before occlusion of the right portal vein and prior to resection. There were no deaths. The morbidity rate in each group was 5.8% (PVE, 1 abscess; PVL, 1 bile leak). The increase in liver volume was significantly higher after PVE compared with PVL (188±81 ml vs. 123±58 ml) (P= 0.012). Postoperative hospital stay was significantly shorter after PVE in comparison to PVL (4±2.9 days vs. 8.1±5.1 days;P<0.01). Curative liver resection was performed in 10 of 17 patients after PVE and 11 of 17 patients after PVL. PVE and PVL were found to be feasible and safe methods of increasing the remnant functional liver volume and achieving resectability for extended liver tumors. PVE results in a significantly more efficient increase in liver volume and a shorter hospital stay.
Similar content being viewed by others
References
Nagorney DM, Van HeerdenJA, Ilstrup DM, Adson MA. Primary hepatic malignancy: Surgical management and determinants of survival. Surgery 1989;106:704–709.
Attiyeh FF, Wichern WAJr. Hepatic resection for primary and metastatic tumors. Am J Surg 1988;156:368–372.
Iwatsuki S, Sheahan DG, Starzl TE. The changing face of hepatic resection. Curr Probl Surg 1989;26:281–379.
Vauthey JN, Baer HU, Guastella T, Blumgart LH. Comparison of outcome between extended and nonextended liver resections for neoplasms. Surgery 1993;114:968–975.
Lai ECS, Ng IOL, You KT, et al. Hepatectomy for large hepatocellular carcinoma: The optimal resection margin. World J Surg 1991;15:141–145.
Hughes KS, Simon R, Songhorabodi S, et al. Resection of the liver for colorectal carcinoma metastases: A multi-institutional study of indication for resection. Surgery 1988;103:278–788.
Bozzetti F, Gennari L, Regalia E, et al. Morbidity and mortality after surgical resection of liver tumors. Analysis of 229 cases. Hepatogastroenterology 1992;39:237–241.
The Liver Cancer Study Group of Japan. Survey and follow-up study of primary liver cancer in Japan. Acta Hepatol Jpn 1995;36:208–218.
Iwatsuki S, Starzl T. Personal experience with 411 hepatic resections. Ann Surg 1988;208:421–432.
Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999;229:790–800.
Shuto T, Hirohashi K, Kubo S, et al., Efficacy of major hepatic resection for large hepatocellular carcinoma. Hepatogastroenterology 1999;46:413–416.
Farges O, Malassagne B, Flejou JF, et al. Risk of major liver resection in patients with underlying chronic liver disease. A reappraisal. Ann Surg 1999;229:210–215.
Abdalla EK, Hicks ME, Vauthey JN. Portal vein embolization: Rationale, technique and future prospects. Br J Surg 2001;88:165–175.
Rous P, Larimore LD. Relation of the portal blood to liver maintenance. A demonstration of liver atrophy conditional on compensation. J Exp Med 1920;31:606–632.
Takayasu K, Muramatsu Y, Shima Y, et al. Hepatic lobar atrophy following obstruction of the ipsilateral portal vein from hilar cholangiocarcinoma. Radiology 1986;160:389–393.
Honjo I, Suzuki T, Ozawa K, et al. Ligation of the branch of the portal vein for carcinoma of the liver. Am J Surg 1975;130:296–302.
Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: A preliminary report. Surgery 1990;107:521–527.
Makuuchi M, Kosuge T, Lygidakis NJ. New possibilities for major liver surgery in patients with Klatskin tumors and primary hepatocellular carcinoma, an old problem revisited. Hepatogastroenterology 1991;38:329–336.
Azoulay D, Castaing D, Smail A, et al. Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 2000;231:480–486.
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;232:665–672.
Vauthey JN, Chaoui A, Do KA, et al. Standardized measurement of the future liver remnant prior to extended liver resection: Methodology and clinical associations. Surgery 2000;127:512–519.
Heymsfield SB, Fulenwider T, Nordlinger B, et al. Accurate measurement of liver, kidney, spleen volume and mass by computerized axial tomography. Ann Intern Med 1979; 90:185–187.
Heinemann A, Wischhusen F, Puschel K, Rogiers X. Standard liver volume in the Caucasian population. Liver Transpl Surg 1999;5:366–368.
Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology 1997;26:1176–1181.
Nagasue N, Yukaya H, Ogawa Y, et al. Human liver regeneration after major hepatic resection. Ann Surg 1987;206:30–39.
Brancatisano R, Isla A, Habib N. Is radical hepatic surgery safe? Am J Surg 1998;175:161–163.
Cunningham JD, Yuman F, Shriver C, et al. One hundred consecutive hepatic resections-Blood loss, transfusion, and operative technique, Arch Surg 1994;129:1050–1056.
Das BC, Isaji S, Kawarada Y. Analysis of 100 consecutive hepatectomies: Risk factors in patients with liver cirrhosis or obstructive jaundice. World J Surg 2001;25:266–272;discussion 272–273.
Azoulay D, Raccula JS, Castaing D, Bismuth H. Right portal vein embolization in preparation for major hepatic resection. J Am Coll Surg 1995;181:266–269.
Nagino M, Nimura Y, Kamiya J, et al. Selective percutaneous transhepatic embolization of the portal vein in preparation for extensive liver resection: The ipsilateral approach. Radiology 1996;200:559–563.
Imamura H, Shimada R, Kubota M, et al. Preoperative portal vein embolization: An audit of 84 patients. Hepatology 1999;29:1099–1105.
Tsuge H, Mimura H, Kawata N, Orita K. Right portal vein embolization before extended right hepatectomy using laparoscopic catheterisation of the ileocolic vein: A prospective study. Surg Laparoscop Endoscop 1994;4:258–263.
Nagino M, Kamiya J, Kanai M, et al. Right trisegment portal vein embolization for biliary tract carcinoma: Technique and clinical utility. Surgery 2000;127:155–160.
Yanaga K, Honda H, Ikeda Y, et al. Significance of liver size in hepatic surgery. HPB Surg 1997;10:195–220.
Denys AL, Abehsera M, Sauvanet A, et al. Failure of right portal vein ligation to induce left lobe hypertrophy due to intrahepatic portoportal collaterals: Successful treatment with portal vein embolization. AJR 1999;173:633–635.
Baere T, Roche A, Vavasseur D, et al. Portal vein embolization: Utility for inducing left hepatic lobe hypertrophy before surgery. Radiology 1993;188:73–77.
Yamakado K, Takeda K, Nishide Y, et al. Portal vein embolization with steel coils and absolute ethanol: A comparative experimental study with canine liver. Hepatology 1995;22:1812–1818.
Ikeda K, Kinoshita H, Hirohashi K, et al. The ultra structure, kinetics and intralobular distribution of apoptotic hepatocytes after portal branch ligation with special reference to their relationship to necrotic hepatocytes. Arch Histol Cytol 1995;58:171–184.
Elias D, Baere T, Roche A, et al. During liver regeneration following right portal embolization the grow rate of liver metastases is more rapid than of the liver parenchyma. Br J Surg 1999;86:784–788.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Broering, D.C., Hillert, C., Krupski, G. et al. Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg 6, 905–913 (2002). https://doi.org/10.1016/S1091-255X(02)00122-1
Issue Date:
DOI: https://doi.org/10.1016/S1091-255X(02)00122-1