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Clinical studies of new material for portal vein embolization: comparison of embolic effect with different agents.

BACKGROUND/AIMS
Study of he embolic materials is necessary to select those suitable for preoperative portal embolization which increases the safety of hepatectomy.


METHODOLOGY
Twenty-three patients with biliary tract cancer and hepatic tumor underwent portal embolization of the right portal vein. Four kinds of embolic materials were used. Gelatin sponge was used in 9, cyanoacrylate in 4, fibrin glue in 2, and gelatin sponge with polidocanol in 8 patients. The embolic effect in inducing hypertrophy as well as the surgical results were compared for different embolic agents. Left lobe hypertrophy was evaluated by computed tomography volume before and 2 weeks after portal embolization.


RESULTS
With gelatin sponge, the volumetric increase was 21.9%, compared to 25% with cyanoacrylate, 13.5% with fibrin glue, and 35.3% for gelatin sponge with polidocanol. The volume increase of gelatin sponge with polidocanol was superior to those of other agents. In 18 of the 21 patients, hepatectomies with/without pancreaticoduodenectomy were performed. In 11 patients using the first 3 of the above-mentioned agents, 2 operative procedures were changed to limited hepatic resection, and 3 patients died of hepatic failure due to insufficient hypertrophy. Seven patients for whom gelatin sponge with polidocanol was used underwent the proposed operations with good results.


CONCLUSIONS
Gelatin sponge with polidocanol induced sufficient hypertrophy and was the most suitable agent for portal embolization.