Preoperative Portal Vein Embolization Alone with Biliary Drainage Compared to a Combination of Simultaneous Portal Vein, Right Hepatic Vein Embolization and Biliary Drainage in Klatskin Tumor.

Autor: Hocquelet A; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, CHUV, Service de radiologie BH07, rue du bugnon 46, 1011, Lausanne, Switzerland. arnaud.hocquelet@chuv.ch., Sotiriadis C; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, CHUV, Service de radiologie BH07, rue du bugnon 46, 1011, Lausanne, Switzerland., Duran R; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, CHUV, Service de radiologie BH07, rue du bugnon 46, 1011, Lausanne, Switzerland., Guiu B; Department of Diagnostic and Interventional Radiology, Montpellier University Hospital, Montpellier, France., Yamaguchi T; Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland., Halkic N; Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland., Melloul E; Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland., Demartines N; Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland., Denys A; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, CHUV, Service de radiologie BH07, rue du bugnon 46, 1011, Lausanne, Switzerland.
Jazyk: angličtina
Zdroj: Cardiovascular and interventional radiology [Cardiovasc Intervent Radiol] 2018 Dec; Vol. 41 (12), pp. 1885-1891. Date of Electronic Publication: 2018 Sep 20.
DOI: 10.1007/s00270-018-2075-0
Abstrakt: Purpose: To compare estimated future remnant liver (FRL) growth following portal vein embolization or liver venous deprivation (LVD) (combined PVE and right hepatic vein embolization), before surgery for a Klatskin tumor in patients who receive intraoperative biliary drainage or before venous interventional radiology.
Material and Method: Six patients underwent LVD and six underwent PVE alone before hepatectomy for a Klatskin tumor. Before embolization, the FRL ratio, prothrombin time and bilirubin levels were similar in both groups. The FRL was determined before and 3 weeks after embolization by enhanced CT. PVE was performed with n-butyl-2-cyanoacrylate, and the right hepatic vein was embolized with vascular plugs during the same procedure. Biliary drainage was performed percutaneously or by endoscopy. Post-hepatectomy liver function and duration of hospital stay were assessed.
Results: There were no adverse events. The median FRL ratio was significantly higher following LVD than after PVE 58% (54-71) and 37% (30-44), respectively, p = 0.017. The FRL volume after embolization was 1.6 times higher after LVD than PVE (p = 0.016). Four and five patients were operated in the LVD and PVE groups, respectively. There was a trend toward a shorter median postoperative hospital stay and 90-day mortality in the LVD versus PVE group: 14 versus 44 days, (p = 0.114) and 0 versus two deaths (p = 0.429), respectively.
Conclusions: LVD associated with biliary drainage is safe and results in a better FRL ratio than biliary drainage associated with PVE alone.
Databáze: MEDLINE
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