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Preoperative Portal Vein Embolization Alone with Biliary Drainage Compared to a Combination of Simultaneous Portal Vein, Right Hepatic Vein Embolization and Biliary Drainage in Klatskin Tumor

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare estimated future remnant liver (FRL) growth following portal vein embolization or liver venous deprivation (LVD) (combined PVE and right hepatic vein embolization), before surgery for a Klatskin tumor in patients who receive intraoperative biliary drainage or before venous interventional radiology.

Material and Method

Six patients underwent LVD and six underwent PVE alone before hepatectomy for a Klatskin tumor. Before embolization, the FRL ratio, prothrombin time and bilirubin levels were similar in both groups. The FRL was determined before and 3 weeks after embolization by enhanced CT. PVE was performed with n-butyl-2-cyanoacrylate, and the right hepatic vein was embolized with vascular plugs during the same procedure. Biliary drainage was performed percutaneously or by endoscopy. Post-hepatectomy liver function and duration of hospital stay were assessed.

Results

There were no adverse events. The median FRL ratio was significantly higher following LVD than after PVE 58% (54–71) and 37% (30–44), respectively, p = 0.017. The FRL volume after embolization was 1.6 times higher after LVD than PVE (p = 0.016). Four and five patients were operated in the LVD and PVE groups, respectively. There was a trend toward a shorter median postoperative hospital stay and 90-day mortality in the LVD versus PVE group: 14 versus 44 days, (p = 0.114) and 0 versus two deaths (p = 0.429), respectively.

Conclusions

LVD associated with biliary drainage is safe and results in a better FRL ratio than biliary drainage associated with PVE alone.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, CHUV, Service de radiologie BH07, rue du bugnon 46, 1011, Lausanne, Switzerland

    Arnaud Hocquelet, Charalampos Sotiriadis, Rafael Duran & Alban Denys

  2. Department of Diagnostic and Interventional Radiology, Montpellier University Hospital, Montpellier, France

    Boris Guiu

  3. Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland

    Takamune Yamaguchi, Nermin Halkic, Emmanuel Melloul & Nicolas Demartines

Authors
  1. Arnaud Hocquelet
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  2. Charalampos Sotiriadis
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  3. Rafael Duran
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  4. Boris Guiu
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Correspondence to Arnaud Hocquelet.

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Hocquelet, A., Sotiriadis, C., Duran, R. et al. Preoperative Portal Vein Embolization Alone with Biliary Drainage Compared to a Combination of Simultaneous Portal Vein, Right Hepatic Vein Embolization and Biliary Drainage in Klatskin Tumor. Cardiovasc Intervent Radiol 41, 1885–1891 (2018). https://doi.org/10.1007/s00270-018-2075-0

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  • DOI: https://doi.org/10.1007/s00270-018-2075-0

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