L'embolisation portale préopératoire: un moyen efficace pour hypertrophier le foie sain et élargir les indications des résections hépatiques

Abstract

The aim of the preoperative portal embolization is a redistribution of the portal venous blood flow in an attempt to induce hypertrophy of the future remnant liver in order to perform a curative liver resection. Preoperative portal embolization was performed in a group of 43 patients. The volumetric ratio (future remnant liver/total liver-tumor) was 20%. Liver metastases were present in 40 patients and primary liver tumor in three. Twenty-four patients had received chemotherapy prior to the preoperative portal embolization. Required operative procedures were right hepatectomy (n = 15), right hepatectomy extended to the segment IV (n = 24) or atypical resection (n = 4). Preoperative portal embolization was performed under percutaneous transhepatic approach with a Blue Histoacryl and Lipiodol Ultra Fluide mixture. Liver volumetric measurements were obtained with 3D color encoded computed tomography, before portal embolization and before surgery. Hypertrophy of the future remnant liver was 83 +/- 58% after a mean 32-day interval between portal embolization and surgery. The tolerance of portal embolization was excellent. Thirty-six hepatectomies were performed as initially planned; seven were cancelled for emergence of metastases (distant in six patients and intrahepatic in one). Pre-operative portal embolization is a safe and effective procedure which increases the possibilities of curative resection in the liver tumors.