Portal vein embolisation prior to extended right-sided hepatic resection

MSL Liem, CL Liu, WK Tso, CM Lo, ST Fan, J Wong
Department of Surgery, Centre for the Study of Liver Disease, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong

OBJECTIVES. To determine whether preoperative portal vein embolisation improves the operative outcome of patients undergoing extended right-sided hepatic resection for hepatobiliary malignancy.

DESIGN. Prospective non-randomised study.

SETTING. University teaching hospital, Hong Kong.

PATIENTS. Ninety-two patients underwent extended right-sided hepatic resection for hepatobiliary malignancy during a 45-month period (January 2000 to September 2003). Among them, 15 (16%) underwent portal vein embolisation via a percutaneous ipsilateral approach (n=9) or through the ileocolic vein with a mini-laparotomy (n=6). The remaining 77 (84%) patients underwent hepatic resection without portal vein embolisation.

MAIN OUTCOME MEASURES. Operative morbidity and mortality.

RESULTS. Patients undergoing portal vein embolisation were older (69 years vs 55 years; P=0.009), and had significantly worse preoperative renal function (creatinine, 96 �mol/L vs 86 �mol/L; P=0.039) and liver function (bilirubin, 23 �mol/L vs 12 �mol/L; P<0.001). Portal vein embolisation resulted in an increase in the future liver remnant of 9% (interquartile range, 7-13%) of the estimated standard liver volume. The operating time for patients receiving portal vein embolisation was significantly longer (medium, 660 min vs 420 min; P<0.001) with more complicated surgery performed in terms of concomitant caudate lobectomy and hepaticojejunostomy. There was no hospital mortality in patients who underwent portal vein embolisation whereas five without treatment died (P=0.587). The operative morbidity of patients who underwent portal vein embolisation and those who did not was 20% and 30%, respectively (P=0.543).

CONCLUSIONS. In older patients who have worse preoperative liver and renal functions, portal vein embolisation enhances the possibility to perform extended right-sided hepatic resection for hepatobiliary malignancies with potentially lower operative mortality and morbidity.

Hong Kong Med J 2005;11:366-72

Key words: Carcinoma, hepatocellular; Cholangiocarcinoma; Embolization, therapeutic; Hepatectomy; Portal vein