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Extension of surgical indications for hepatocellular carcinoma by portal vein embolization

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Abstract

We studied, clinically and experimentally, hypertrophy of the part of the liver not embolized after portal vein embolization (PVE). The subjects of the clinical study were 29 patients with hepatocellular carcinoma (HCC) who underwent embolization of the right first portal branch; 19 patients had cirrhosis, and 10 did not. The volume of the liver was calculated from computed tomograms obtained before PVE and 2 weeks after. In all patients, the volume of the nonembolized (left) lobe increased significantly. For the experimental study, we used male Wistar rats. Normal rats were untreated, and in the other rats cirrhosis was induced with carbon tetrachloride. The portal branch that supplies 70% of the total volume of the liver was embolized. The rats underwent one of four procedures: 70% PVE, 70% portal vein ligation, 70% hepatectomy, or laparotomy only. Rats were killed at different times after surgery, and the livers were removed and weighed. The mitotic index and DNA synthesis were measured in the nonembolized lobe (PVE group), in the lobe not supplied by the ligated branch (ligation group), or in the remaining liver (hepatectomy group). The liver weight, mitotic index, and DNA synthesis were high in the PVE, ligation, and hepatectomy groups for both normal rats and rats with cirrhosis. PVE caused cell proliferation and hypertrophy in the nonembolized part of the liver in the normal rats and even in those with cirrhosis. We concluded that PVE can extend the surgical indications for patients with HCC and underlying cirrhosis.

Résumé

Une étude clinique et expérimentale de l'hypertrophie du foie controlatéral a été réalisée chez les patients ayant eu une embolisation portale sélective (EP), Dans l'étude clinique, parmi les 29 patients ayant un carcinome hépatocellulaire (CHC) et ayant eu une embolisation de la droit première branche porte, 19 avaient une cirrhose, 10 n'en avaient pas. Le volume du foie a été déterminé avant et 2 semaines après EP par tomodensitométrie. Chez tous les patients, le volume du lobe hépatique non embolisé (lobe gauche) a augmenté de volume de faÇon significative. Dans l'étude expérimentale, on a induit une cirrhose par ingestion de tétrachlorure de carbone chez des rats Wistar. La branche porte correspondant à 70% du volume total du foie a été embolisée. Quatre types d'interventions ont été réalisées: EP de 70% du volume hépatique, ligature de 70% du territoire hépatique, hépatectomie de 70%, ou laparotomie exploratrice. Les rats ont été sacrifiés 1 à 14 jours après l'intervention. Le poids hépatique, l'index de mitoses, et la syntèse en ADN étaient élevés chez les rats avec ou sans cirrhose. L'EP était associée à une prolifération cellulaire et une hypertrophie du lobe non embolisé chez les rats normaux ou cirrhotiques. On conclut que l'EP peut étendre les indications de résection chirurgicale chez le patient ayant un CHC associé à une cirrhose.

Resumen

Hemos estudiado la hipertrofia de la parte del hígado no embolizado después de embolización venosa portal (EVP) desde el aspecto clínico como experimental. La población del estudio estuvo constituído por 29 pacientes con carcinoma hepatocelular (CHC) sometidos a embolización de la primera derecha rama de la vena porta; 19 tenían cirrosis y 10 no eran cirróticos. El volumen del hígado fue calculado a partir de tomogramas computadorizados tornados antes de la EVP y dos semanas después. En todos los pacientes el volÚmen del lóbulo no embolizado aumentó en forma significativa. Se utilizaron ratas Wistar machos para el estudio experimental. Las ratas normales no recibieron tratamiento, y en las otras se indujo cirrosis con tetracloruro de carbono. La rama portal que irriga el 70% del volumen hepático total fue embolizada. Las ratas fueron sometidas a uno de cuatro procedimientos: 70% EVP, 70% ligadura de la vena portal, 70% hepatectomia o laparotomía simple; los animales fueron sacrificados a diferentes intervalos luego de la cirugía y los hígados removidos y pesados. Se determinaron el indice mitótico y la síntesis de DNA en el lóbulo no embolizado (grupo EVP), en el lóbulo no irrigado por la rama portal ligada (grupo ligadura) o en el hígado remanente (grupo hepatectomía). Tanto el peso del hígado como el indice mitótico y la síntesis de DNA aparecieron elevados en los grupos EVP, ligadura y hepatectomia tanto en ratas normales como en las cirróticas. La EVP causó proliferación celular e hipertrofia en la parte no embolizada del hígado en las ratas normales y aÚn en las ratas con cirrosis. Por consiguiente, la EVP amplifica las indicaciones quirÚrgicas en pacientes con CHC y cirrosis subyacente.

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Authors and Affiliations

  1. Second Dept. of Surgery, Osaka City University Medical School, 1-5-7 Asahimachi, Abeno-ku, 545, Osaka, Japan

    Kwang Choon Lee M.D., Hiroaki Kinoshita M.D., Kazuhiro Hirohashi M.D., Shoji Kubo M.D. & Ryutaro Iwasa M.D.

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  1. Kwang Choon Lee M.D.
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  2. Hiroaki Kinoshita M.D.
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  3. Kazuhiro Hirohashi M.D.
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  4. Shoji Kubo M.D.
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  5. Ryutaro Iwasa M.D.
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Lee, K.C., Kinoshita, H., Hirohashi, K. et al. Extension of surgical indications for hepatocellular carcinoma by portal vein embolization. World J. Surg. 17, 109–115 (1993). https://doi.org/10.1007/BF01655721

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