Liver Cancer
Copyright ©The Author(s) 2003. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 15, 2003; 9(8): 1702-1706
Published online Aug 15, 2003. doi: 10.3748/wjg.v9.i8.1702
Role of preoperative selective portal vein embolization in two-step curative hepatectomy for hepatocellular carcinoma
Wu Ji, Jie-Shou Li, Ling-Tang Li, Wu-Hong Liu, Kuan-Sheng Ma, Xiang-Tian Wang, Zhen-Ping He, Jia-Hong Dong
Wu Ji, Jie-Shou Li, Ling-Tang Li, Research Institute of General Surgery, Nanjing General Hospital of Nanjing PLA Command Area, Nanjing 210002, Jiangsu Province, China
Wu Ji, Wu-Hong Liu, Xiang-Tian Wang, Department of General Surgery, Kunming General Hospital of Chengdu PLA Command Area, Kunming 650032, Yunnan Province, China
Kuan-Sheng Ma, Zhen-Ping He, Jia-Hong Dong, Hepatobiliary Surgery Center, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Wu Ji, MD, Institute of General Surgery, Nanjing General Hospital of Nanjing PLA Command Area, 305 Eastern Zhongshan Road, Nanjing, 210002, Jiangsu Province, China.
Telephone: +86-25-4826808 Ext 58007 Fax: +86-25-4820160
Received: November 6, 2002
Revised: November 16, 2002
Accepted: December 7, 2002
Published online: August 15, 2003

AIM: To determine the feasibility and role of ultrasound-guided preoperative selective portal vein embolization (POSPVE) in the two-step hepatectomy of patients with advanced primary hepatocellular carcinoma (HCC).

METHODS: Fifty patients with advanced HCC who were not suitable for curative hepatectomy were treated by ultrasound-guided percutaneous transhepatic POSPVE with fine needles. The successful rate, side effects and complications of POSPVE, changes of hepatic lobe volume and two-step curative hepatectomy rate after POSPVE were observed.

RESULTS: POSPVE was successfully performed in 47 (94.0%) patients. In patients whose right portal vein branches were embolized, their right hepatic volume decreased and left hepatic volume increased gradually. The ratio of right hepatic volume to total hepatic volume decreased from 62.4% before POSPVE to 60.5%, 57.2% and 52.8% after 1, 2 and 3 weeks respectively. The side effects included different degree of pain in liver area (38 cases), slight fever (27 cases), nausea and vomiting (9 cases). The level of aspartate alanine transaminase (AST), alanine transaminase (ALT) and total bilirubin (TBIL) increased after POSPVE, but returned to preoperative level in 1 week. After 2-4 weeks, two-step curative hepatectomy for HCC was successfully performed on 23 (52.3%) patients. There were no such severe complications as ectopic embolization, local hemorrhage and bile leakage.

CONCLUSION: Ultrasound-guided percutaneous transhepatic POSPVE with fine needles is feasible and safe. It can extend the indications of curative hepatectomy of HCC, and increase the safety of hepatectomy.

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