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Preoperative selective portal vein embolization in two-step hepatectomy for hepatocellular carcinoma in injured livers: a preliminary report.

OBJECTIVE
To study the effect of preoperative selective portal vein embolization (SPVE) in the two-step hepatectomy for patients with primary hepatocellular carcinoma (HCC) in injured livers.


METHODS
Twenty-six patients with HCC and cirrhosis who were not suitable for curative hepatectomy were treated by ultrasound-guided percutaneous transhepatic SPVE with a fine needle. The success rate, side-effects and complications of SPVE, serial changes of hepatic lobe volume and rate of two-step curative hepatectomy after SPVE were observed.


RESULTS
SPVE was performed in 24 patients (92.3%). In patients whose right portal vein branches were embolized, the right hepatic volume decreased but the left hepatic volume increased gradually. The ratio of the right hepatic volume to the total hepatic volume decreased from 64.0% before SPVE to 60.8% after l week, 55.1% after 2 weeks and 52.7% after 3 weeks, respectively. The side-effects included different degree of pain in the liver quandrant (17 patients), lower fever (9), and nausea and vomiting (7). The levels of aspartate alanine transaminase (AST), alanine transaminase (ALT) and total bilirubin (TBIL) increased after SPVE, but returned to the preoperative levels in 1 week. After 2-4 weeks, two-step curative hepatectomy for HCC was performed in 13 patients (54.2%).


CONCLUSIONS
Ultrasound-guided percutaneous transhepatic SPVE with a fine needle is feasible and safe. It can extend the indications of curative hepatectomy for HCC in injured livers, and increase the safety of two-step hepatectomy.