Preoperative Portal Vein Embolization Alone with Biliary Drainage Compared to a Combination of Simultaneous Portal Vein, Right Hepatic Vein Embolization and Biliary Drainage in Klatskin Tumor

Abstract

To compare estimated future remnant liver (FRL) growth following portal vein embolization or liver venous deprivation (LVD) (combined PVE and right hepatic vein embolization), before surgery for a Klatskin tumor in patients who receive intraoperative biliary drainage or before venous interventional radiology. Six patients underwent LVD and six underwent PVE alone before hepatectomy for a Klatskin tumor. Before embolization, the FRL ratio, prothrombin time and bilirubin levels were similar in both groups. The FRL was determined before and 3weeks after embolization by enhanced CT. PVE was performed with n-butyl-2-cyanoacrylate, and the right hepatic vein was embolized with vascular plugs during the same procedure. Biliary drainage was performed percutaneously or by endoscopy. Post-hepatectomy liver function and duration of hospital stay were assessed. There were no adverse events. The median FRL ratio was significantly higher following LVD than after PVE 58% (54-71) and 37% (30-44), respectively, p = 0.017. The FRL volume after embolization was 1.6 times higher after LVD than PVE (p = 0.016). Four and five patients were operated in the LVD and PVE groups, respectively. There was a trend toward a shorter median postoperative hospital stay and 90-day mortality in the LVD versus PVE group: 14 versus 44days, (p = 0.114) and 0 versus two deaths (p = 0.429), respectively. LVD associated with biliary drainage is safe and results in a better FRL ratio than biliary drainage associated with PVE alone.