Is embolization of segment 4 portal veins before extended right hepatectomy justified?

Background Preoperative portal vein embolization (PVE) is increasingly used as a preparation for major hepatectomy in patients with inadequate liver remnant volume or function. However, whether segment 4 (S4) portal veins should be embolized is controversial. The effect of S4 PVE on the volume gain...

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Bibliographic Details
Published in:Surgery 2008-11, Vol.144 (5), p.744-751
Main Authors: Kishi, Yoji, MD, Madoff, David C., MD, Abdalla, Eddie K., MD, Palavecino, Martin, MD, Ribero, Dario, MD, Chun, Yun Shin, MD, Vauthey, Jean-Nicolas, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Angioplasty
Biological and medical sciences
Cohort Studies
Embolization, Therapeutic
Female
General aspects
Hepatectomy - methods
Humans
Liver Neoplasms - diagnostic imaging
Liver Neoplasms - pathology
Liver Neoplasms - surgery
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical sciences
Middle Aged
Organ Size
Portal Vein
Radiography
Retrospective Studies
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Treatment Outcome
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Summary:Background Preoperative portal vein embolization (PVE) is increasingly used as a preparation for major hepatectomy in patients with inadequate liver remnant volume or function. However, whether segment 4 (S4) portal veins should be embolized is controversial. The effect of S4 PVE on the volume gain of segments 2 and 3 (S2+3) was examined. Methods Among 73 patients with uninjured liver who underwent right portal vein embolization (RPVE, n = 15) or RPVE extended to S4 portal veins (RPVE+4, n = 58), volume changes in S2+3 and S4 after embolization were compared. Clinical outcomes and PVE complications were assessed. Results After a median of 27 days, the S2+3 volume increased significantly after both RPVE and RPVE+4, but the absolute increase was significantly higher for RPVE+4 (median, 106 mL vs 141 mL; P = .044), as was the hypertrophy rate (median, 26% vs 54%; P = .021). There was no significant difference between RPVE and RPVE+4 in the absolute S4 volume increase (52 mL for RPVE vs 55 mL for RPVE+4; P = .61) or the hypertrophy rate of S4 (30% for RPVE vs 26% for RPVE+4; P = .45). Complications of PVE occurred in 1 patient (7%) after RPVE and 6 (10%) after RPVE+4 ( P > .99). No PVE complication precluded subsequent resection. Curative hepatectomy was performed in 13 patients (87%) after RPVE and 40 (69%) after RPVE+4 ( P = .21). Conclusions RPVE+4 significantly improves S2+3 hypertrophy compared with RPVE alone. Extending RPVE to S4 does not increase PVE-associated complications.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2008.05.015