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Original Communication| Volume 143, ISSUE 4, P476-482, April 2008

Preoperative contralateral portal vein embolization before major hepatic resection is a safe and efficient procedure: A large single institution experience

  • Giorgio Giraudo
    Affiliations
    Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur Avenue Molière, Strasbourg, France
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  • Michel Greget
    Affiliations
    Service de Radiologie I, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur Avenue Molière, Strasbourg, France
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  • Elie Oussoultzoglou
    Affiliations
    Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur Avenue Molière, Strasbourg, France
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  • Edoardo Rosso
    Affiliations
    Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur Avenue Molière, Strasbourg, France
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  • Philippe Bachellier
    Affiliations
    Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur Avenue Molière, Strasbourg, France
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  • Daniel Jaeck
    Correspondence
    Reprint requests: Daniel Jaeck, Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur, Avenue Molière, Strasbourg, France.
    Affiliations
    Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur Avenue Molière, Strasbourg, France
    Search for articles by this author

      Background

      The aim of this study was to report the results of preoperative contralateral portal vein embolization (PVE) performed in a single institution.

      Methods

      Between January 1997 and March 2006, 146 patients requiring a right or extended right hepatectomy for primary or secondary liver tumors underwent contralateral PVE when the future remnant liver volume (FRL) was less than 30% of total liver. Liver volumes and hepatic function were evaluated before and after PVE.

      Results

      Contralateral PVE was performed successfully in 145 patients. In one patient, the catheterization of the left portal branch failed. Complications occurred in 14 patients (10%) including a transitory fever (n = 9), a parenchymal hematoma (n = 1), a mild hemoperitoneum (n = 1), a mesenterico-portal venous thrombosis (n = 1), a pulmonary embolism (n = 1) and a systemic sepsis (n = 1). The prothrombine ratio and the platelet count were significantly lower 3 days after PVE. Insufficient hypertrophy of the FRL was observed in 8 patients, malignant disease progression in 15, and both insufficient hypertrophy and disease progression in 4. The hypertrophy rate of the FRL 4 to 8 weeks after PVE was 47.7 ± 31.9%. Pathological type of the liver tumor, cirrhosis, diabetes mellitus, and chemotherapy did not affect the volume of the left liver hypertrophy. However, the time required to achieve an adequate liver hypertrophy was significantly shorter in patients with normal liver. One-hundred and fourteen patients (78.6%) subsequently underwent hepatic resection.

      Conclusions

      The results suggest that contralateral PVE is a safe and efficient procedure inducing adequate hypertrophy of the FRL before major liver resection.
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