Роль ендоваскулярних методик ремоделювання печінки в хірургічній гепатології

Abstract

Objective — to study the results of surgical treatment of patients with liver tumors who underwent embolization of the portal vein branches (PVE) as a remodeling of the planned hepatic remnant. Materials and methods. PVE was performed in 485 patients in the period from 2003 to 2018. For all patients the calculation of the volume of the planned hepatic balance was performed before PVE and before liver resection. The level of postoperative morbidity and mortality, as well as long-term overall and recurrence-free survival was investigated comparing a group of patients who were not treated with PVE before resection of the liver. Results. In all patients after the portal vein embolization, an increase in the residual volume of the liver was observed on average by 58.6 %. The degree of hypertrophy was found to depend on the extention of embolization performed. Radical resection of the liver was performed in 397 (81.9 %) patients. In the main group of patients, a decrease in the incidence of acute postoperative liver failure from 9.3 % to 2.3% was observed and the decrease in postoperative mortality from 8.8 % to 4.6 %. Compared to the group of patients, were the endovascular remodeling techniques before liver resection had not been used. Distant total 3-year and 5-year postoperative survival in these groups is not significantly different. Conclusions. Embolization of the portal vein branches is a necessary method of preparing patients with a small estimated hepatic remnant for expanded liver resection and allows to reduce postoperative morbidity and mortality in this group of patients.