Combined preoperative embolization of the right portal vein and hepatic artery for hepatic resection in a high-risk patient.

Abstract

A bout 90% of patients with primary hepatocellular carcinoma have unresectable disease at presentation [1 1;hepatic resection is the only curative treatment for the remaining 10% of patients. Chronic liver disease and liver cirrhosis, which preexist in up to 80% of patients with hepatocellular carcinoma, are associated with a significant increase in postoperative liver failure and mortality, thus reducing the disease resectability rates. Scoring systems have been develo_ [2, 3] to predict postoperative outcome in patients undergoing hepatectomy and thus improve the selection for surgery. The parenchymal hepatic resection rate-the percentage of the functioning liver volume to be resected to the entire functioning liver volume-is a major predictor of outcome [2, 3]. Preoperative transhepatic portal vein embolization has been used to induce atrophy of the corresponding liver lobe and a compensatory hypertrophy of the contralateral lobe [4] and hence increase resectability [5]. However, preoperative portal vein embolization may not always be sufficient to achieve the desired changes in hepatic volume and function and thus may fail to avert the onset of postoperative hepatic failure [6]. In such cases, additional measures that may augment hypertrophy within the remaining liver are desirable. This report describes the beneficial role of transcatheter arterial embolization performed after madequate response to a preoperative transhepatic portal vein embolization in a high-risk patient with hepatocellular carcinoma.