Utility of portal vein embolization in surgical management of locally advanced gallbladder cancer

Abstract

Introduction: Portal vein embolization (PVE) enables surgical resection of hepatobiliary tumours which would otherwise be unresectable due to insufficient future liver remnant (FLR). Here, we evaluated the outcomes after PVE for carcinoma gallbladder (CaGB) cases necessitating major hepatectomy. Methods: Between August 2015 to July 2016, seventeen patients with CaGB needing extended right hepatectomy but having insufficient FLR on CT volumetry were offered PVE. Preoperative biliary drainage (PBD) was done to decrease bilirubin to <5mg/dL. Right PVE was done by ipsilateral approach using glue and lipiodal. Volumes were reassessed after 4 weeks before considering for surgery. Results: All the 17 cases were jaundiced and therefore required PBD. 2 patients had received neo-adjuvant chemo-radiotherapy. Technical success was achieved in all and there were no procedure related complications. Mean baseline segment 2+3 volume was 16.46 ± 5.07 % which increased to 25.34 ± 7.01% post embolization. Only 2 patients could undergo curative surgery despite increase in FLR, one of whom required ALPPS procedure due to inadequate FLR on intra-operative assessment. 8 cases had tumour progression, 2 developed main portal vein thrombosis, 1 developed portal hypertension, 3 had persistent sepsis or poor performance status and 1 defaulted. There was no post operative liver failure in the operated patients. Conclusions: FLR increase after PVE doesn't translate into improved resectabilty in locally advanced but resectable CaGB cases due to further disease progression. Hence, alternative approaches should be considered in these subset of patients.