Abstract
Purpose: To evaluate the clinical efficacy and safety of preoperative percutaneous transhepatic portal
vein embolization (PVE) with an ipsilateral approach, using microfibrillar collagen (MFC) as an embolic material for
carcinomas of the biliary tract and liver metastases of colorectal carcinoma.
Materials and methods: PVE using MFC was performed in 35 consecutive patients (29 men and 6 women; mean age 64 years, range 44–81 years) with small estimated future liver remnants (FLRs) after planned major hepatectomy. Patient malignancies included bile duct carcinoma (n = 20), gallbladder carcinoma (n = 5), and metastases of colorectal carcinoma (n = 8). In one patient preoperatively diagnosed with gallbladder carcinoma, the pathological diagnosis of xanthogranulomatous cholecystitis was confirmed after resection. PVE was performed with ultrasound guidance (ipsilateral approach, 35; contralateral approach, 1). Total liver volume (TLV) and FLR changes, hypertrophy ratio before and after PVE, and procedure-related complications were analyzed retrospectively.
Results: PVE was successful in all patients. There were no major procedure-related complications. Mean absolute FLR volume increased significantly (p < 0.001) from 434 to 524 cm³, as did the standardized FLR to TLV ratio (p < 0.001）, from a mean of 37.9% to 46.1%. The mean ratio of standardized FLR increase was 8.2%. The hypertrophy ratio was 23%. In the group receiving selective embolization in a centripetal direction, the increase in FLR/TLV ratio was 9.5%, while the hypertrophy ratio was 27%. Neither puncture-related complications nor deterioration of liver function were observed.
Conclusion: MFC was a safe and effective embolic material for preoperative PVE in patients with hepatobiliary malignancies, resulting in sufficient hypertrophy of FLRs.
