Preoperative portal vein embolization: An audit of 84 patients

Preoperative portal vein embolization (PVE) was performed in 84 patients be fore extensive liver resection for various diseases. By the criteria of liv er volumetric determination, some patients were candidates for PVE, whereas others were not, even though the same surgical procedure, such as extended right lobectomy (ERL), was scheduled. PVE using gelatin sponge powder indu ced hypertrophy in the nonembolized lobe (0%-171%; median, 30%) and proport ional atrophy in the embolized lobe in 2 weeks without eliciting any major inflammatory or necrotic reaction, as evidenced histologically and by the m inimal elevations in the serum aspartate transaminase (AST) and alanine tra nsaminase (ALT) values. Alterations in the total bilirubin level and prothr ombin time were also insignificant and transient, indicating that hepatocyt e functions were not impaired by PVE. Not all patients who undergo PVE proc eed with the scheduled hepatic resection procedure, so it is a great advant age that gelatin sponge causes minimal damage compared with other embolizin g materials such as cyanoacrylate and absolute ethanol, which have been rep orted to induce an inflammatory reaction or histological alteration. Our mu ltiple regression analysis showed that three factors, diabetes mellitus, a high total bilirubin level at the time of PVE, and being male, each reduced the extent of hypertrophy in the nonembolized lobe (r(2) = .30). By contra st, cholestasis appeared to accelerate the process of atrophy in the emboli zed lobe (r(2) =,16). In conclusion, PVE by gelatin sponge powder is a safe and effective preoperative maneuver that induces hypertrophy of the sectio n of the Liver that will remain after partial hepatectomy.