Percutaneous preoperative portal vein embolization using a combination of gelatin sponge and histoacryl glue

Abstract

Inadequate remnant liver volume is a major cause of postoperative liver failure. Preoperative portal vein embolization (PVE) is used clinically to prevent postoperative liver insufficiency. To evaluate the efficacy and safety of preoperative portal vein embolization, by using a combination of gelatin sponge and histoacryl to induce hypertrophy of future liver remnant (FLR) in patients with a hepatobiliary malignancy. PVE using a combination of gelatin sponge and histoacryl glue was performed in 11 patients (nine men, two women; mean age 60 years, range 46-70 years). These patients were diagnosed with a hepatobiliary malignancy before surgery and their FLR volumes were judged as insufficient to allow for safe resection (FLR <25% in patients with a normal liver or FLR <40% in patients with a chronic liver disease). Liver volume changes, levels of biochemical markers, complications related to PVE, and postoperative complications were retrospectively evaluated. PVE was successful in all patients, and there were no procedural complications. The enlargement of nonembolized liver lobe was 30% (mean 118 cm3). A planned hepatectomy was cancelled in four patients due to the presence of a late-detected extrahepatic metastasis. Seven of the 11 patients underwent hepatectomy without complications. Preoperative PVE with a combination of gelatin sponge and histoacryl glue is a safe and effective procedure to induce hypertrophy of nonembolized parts of the liver.