Preoperative Portal Vein Embolization in the Combined Treatment of Malignant Liver Tumor

Abstract

Aim. To improve the efficiency of preoperative portal vein mbolization as a method of prevention of postoperative liver failure after extensive resections. Material and Methods. The study included 30 patients with isolated liver tumors in whom advanced liver resection was planned. 33 embolizations were performed. In 23 observations mechanical embolization and scleroobliteration of the right branch of portal vein were made, oily chemoembolization and mechanical embolization of the right branch of the portal vein – in 10 cases. In 8 cases preoperative portal vein embolization was performed after oily chemoembolization of hepatic artery. 3 patients underwent repeated portal vein embolization due to insufficient hypertrophy of the remaining liver parenchyma. Results. Volume of remnant liver parenchyma increased by 41% after preoperative portal vein embolization on the average. In 5 cases insufficient volume of remnant liver was marked. The reasons of insufficient liver volume were partial recanalization of the embolized branches of the portal vein, the development of multiple intrahepatic portal collaterals (hemostatic spongeas as a embolic material in 3 cases), liver cirrhosis and 2 lines of previous chemotherapy in history (2 cases). In 3 patients repeated portal vein embolization using PVA particles and scleroobliteration with etoxisclerol foam was performed to achieve necessary hypertrophy. Extensive liver resection was performed in 24 patients. Postoperative mortality was noted in 2 cases. There was similar frequency of postoperative complications in patients with and without preoperative portal vein embolization. Conclusion. Preoperative portal vein embolization is a minimally invasive technique for increase of remnant liver volume prior to advanced liver resection without augmentation of postoperative complications rate. The results and technique may be improved (segment IV branch embolization, the use of foam scleroobliteration, mechanical occlusion combined with chemoembolization, combination of portal vein embolization and hepatic artery chemoembolization). Repeated embolization procedures can provide necessary liver hypertrophy in some cases