Vascular complications following selective portal venous embolisation - Is postinterventional extended liver resection still possible?

Abstract

Background: Planning strategy for extended liver resection in patients with intrahepatic malignomas is usually based on 2 dimensional(2-D) CT-Scans.In selected cases extension of 2-D scans with virtual 3 dimensional(3-D) liver reconstructions to improve the presentation of the intrahepatic vascular topography,tumor burden and the suspending segmental volumes is necessary to maintain a functional suitable “remnant liver volume"(RLV).If RLV is insufficient portal venous embolization(PVE) is one of the most common procedures to improve liver function reserve. Methods: We report about a 60 y old male patient suffering from colon carcinoma with synchronous bilateral liver metastases.After rectal resection and completing adjuvant chemotherapy restaging CT scan showed downsizing of the remainig right sided liver metastases.During liver resection additional metastases in segment I, II and III were found and resected.As LRV was to small operation was terminated and a PVE of the right portal branch was initiated with accidental spread of embolization fluid into the left portal venous branch as well. Results: Finally 3-D CT-Scans showed progredient volume growth with sufficient LRV to perform extended right hemihepatectomy including segment I.Complete tumor resection was achieved. Conclusion: Eventhoogh a major complication during PVE with an almost complete occlusion of the left sided portal venous branch occured.We recommand extended virtual 3-D reconstruction to evaluate RLV for proper resection planning.