[Induction of hypertrophy of a small left hepatic lobe by preoperative right portal embolization, preceding extended right hepatectomy].

The aim of this study was to evaluate the compensatory hypertrophy of the left lobe of the liver, induced by a preoperative right portal embolization (PORPE), and then the feasibility of a right extended hepatectomy. The small size of the left lobe did not initially permit such a resection. Eight patients (mean age: 62 years) underwent PORPE for cancer between September 1987 and December 1991. They represented 4% of the 187 patients undergoing hepatectomy for liver cancer during the same period. The PORPE was conducted by percutaneous access and puncture of the left portal vein (Rex's recessus). The clinical and laboratory safety were good, with fewer adverse effects than with arterial chemo-embolization. The mean increased volume of the left lobe, four weeks after PORPE, was 54% (range: 32-100%) allowing hepatectomy to be performed. The post-operative course of these right extended hepatectomies was uneventful. In conclusion, we think that PORPE needs a careful technique but that it is well tolerated and effective to induce hypertrophy of the future remnant left lobe. It allows resection of some initially unresectable tumors. This technique warrants further development.