Hadrien Tranchart1, Laurence Catherine2, Sophie Maitre2, Panagiotis Lainas3, Jocelyne De Laveaucoupet2, Ibrahim Dagher3. 1. Department of Minimally Invasive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, Clamart F-92140, France; Paris-Sud University, Orsay, France.. Electronic address: hadrien.tranchart@abc.aphp.fr. 2. Department of Radiology, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, Clamart F-92140, France; Paris-Sud University, Orsay, France. 3. Department of Minimally Invasive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, Clamart F-92140, France; Paris-Sud University, Orsay, France.
Abstract
PURPOSE: To report initial experience of temporary portal vein embolization (PVE) with a powdered form of absorbable gelatin sponge before major liver resection. MATERIALS AND METHODS: From 2009-2013, 20 patients (6 women and 14 men; median age, 61.5 y ± 2.8; range, 49-80 y) considered for major liver resections for both primary and secondary hepatic malignancies underwent temporary PVE. Data were retrospectively reviewed. Embolization of selected portal vein segments was performed using the powdered form of an absorbable gelatin sponge. All patients underwent volumetric computed tomography (CT) assessment before and at 4-6 weeks after PVE. Liver histology was normal in 13 patients; 1 patient had steatosis, and 6 patients had cirrhosis. RESULTS: Subsegmental, segmental, and sectorial embolization was successfully performed in all patients. None of the patients developed liver insufficiency or fever after embolization. Volumetric CT assessment showed the disappearance of all portal thrombosis in 14 patients. The median hypertrophy ratio of the nonembolized liver was 29.4% ± 6.9 (range, 3.3-127.2%). Of 20 patients, 15 underwent surgery 1-2 months after temporary PVE. One (6.7%) patient presented with liver decompensation in the postoperative period. Five patients were not eligible for surgery because of tumor progression. Histologic examination of the resected liver revealed the presence of absorbable gelatin sponge powder in a few distal portal tracts in four patients. No residual absorbable gelatin sponge powder was observed in portal vessels in the remaining 11 patients. CONCLUSIONS: Temporary PVE resulted in sufficient hypertrophy of the liver that did not receive embolization to enable surgical planning in all patients in our series.
PURPOSE: To report initial experience of temporary portal vein embolization (PVE) with a powdered form of absorbable gelatin sponge before major liver resection. MATERIALS AND METHODS: From 2009-2013, 20 patients (6 women and 14 men; median age, 61.5 y ± 2.8; range, 49-80 y) considered for major liver resections for both primary and secondary hepatic malignancies underwent temporary PVE. Data were retrospectively reviewed. Embolization of selected portal vein segments was performed using the powdered form of an absorbable gelatin sponge. All patients underwent volumetric computed tomography (CT) assessment before and at 4-6 weeks after PVE. Liver histology was normal in 13 patients; 1 patient had steatosis, and 6 patients had cirrhosis. RESULTS: Subsegmental, segmental, and sectorial embolization was successfully performed in all patients. None of the patients developed liver insufficiency or fever after embolization. Volumetric CT assessment showed the disappearance of all portal thrombosis in 14 patients. The median hypertrophy ratio of the nonembolized liver was 29.4% ± 6.9 (range, 3.3-127.2%). Of 20 patients, 15 underwent surgery 1-2 months after temporary PVE. One (6.7%) patient presented with liver decompensation in the postoperative period. Five patients were not eligible for surgery because of tumor progression. Histologic examination of the resected liver revealed the presence of absorbable gelatin sponge powder in a few distal portal tracts in four patients. No residual absorbable gelatin sponge powder was observed in portal vessels in the remaining 11 patients. CONCLUSIONS: Temporary PVE resulted in sufficient hypertrophy of the liver that did not receive embolization to enable surgical planning in all patients in our series.
Authors: Danny van der Helm; Marieke C Barnhoorn; Eveline S M de Jonge-Muller; Ilse Molendijk; Luuk J A C Hawinkels; Minneke J Coenraad; Bart van Hoek; Hein W Verspaget Journal: J Cell Mol Med Date: 2019-06-27 Impact factor: 5.310
Authors: Celeste Del Basso; Martin Gaillard; Panagiotis Lainas; Stella Zervaki; Gabriel Perlemuter; Pierre Chagué; Laurence Rocher; Cosmin Sebastian Voican; Ibrahim Dagher; Hadrien Tranchart Journal: World J Hepatol Date: 2021-11-27