Efficacy and safety of preoperative percutaneous transhepatic portal embolization with absolute ethanol: A clinical study

• Published in: Surgery Vol. 121; no. 2; pp. 135 - 141
• Main Authors: Shimamura, Tsuyoshi, Nakajima, Yasuaki, Une, Yoshie, Namieno, Tsutomu, Ogasawara, Kazuhiro, Yamashita, Kenichiro, Haneda, Tsutomu, Nakanishi, Kazuaki, Kimura, Jun, Matsushita, Michiaki, Sato, Naoki, Uchino, Junichi
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-02-1997; Elsevier
• Subjects: Adult; Aged; Alanine Transaminase - blood; Biological and medical sciences; Carcinoma, Hepatocellular - surgery; Diseases of the digestive system; Embolization, Therapeutic - adverse effects; Ethanol - administration & dosage; Female; Hepatectomy - adverse effects; Humans; Liver - pathology; Liver - physiopathology; Liver Neoplasms - surgery; Liver Regeneration; Male; Medical sciences; Middle Aged; Portal Vein; Postoperative Complications; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Human; Ethanol; Treatment efficiency; Instrumentation therapy; Hepatic disease; Hepatocellular carcinoma; Malignant tumor; Percutaneous route; Surgery; Digestive diseases; Embolization; Preoperative; Safety; Portal vein; Lobectomy
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/S0039-6060(97)90282-8

Background. Preoperative portal embolization has been performed by using various thrombogenic substances to increase the safety and resectability of liver surgery. We evaluated the clinical safety and efficacy of using absolute ethanol in preoperative portal embolization.
Methods. Our study included 19 patients who had undergone right hepatic lobectomy. According to our criteria for right lobectomy of the liver, seven patients were not appropriate for the operation because of a high risk in each of postoperative liver failure. Those patients received preoperative right portal embolization with 11 to 32 ml absolute ethanol. The remaining 12 patients satisfied our criteria and received no preoperative embolization.
Results. Although alanine aminotransferase concentrations increased dramatically after the embolization, all serologic changes reverted within 3 weeks. The mean volume of the nonembolized lobe increased from 320 cm
3 to 619 cm
3 and 667 cm
3 2 and 4 weeks, respectively, after embolization. The mean regeneration rate of this lobe was 21.3 cm
3 per day for the first 2 weeks and 11.4 cm
3 per day for the first 4 weeks after embolization. All patients underwent right lobectomy of the liver and survived; none of the patients had severe complications associated with embolization or surgery. The postoperative survival periods were not statistically significant between the patients with and without preoperative portal embolization.
Conclusions. According to our criteria for liver surgery, the seven patients should not have undergone major surgery, but each underwent right lobectomy of the liver and all survived, showing that portal embolization with absolute ethanol brings about compensatory hepatic hypertrophy for major surgery and that its extreme effect on liver regeneration could widen the range of patients appropriate for liver surgery.