for patients who undergo curative resection. 6 Unfortunately, To render hepatectomy feasible in patients with an the percentage of patients likely to benefit from hepatic resecinitially deficient volume of the future remnant liver tion ranges from 5% 7 to 10% 8 in patients with adenocarci-(FRL), we redistributed portal blood flow rich in hepatonoma of the colon. trophic substances toward the FRL. Redistribution was
As portal vein blood flow has hepatotrophic properties, 9 we achieved with preoperative portal vein embolization decided to reroute portal blood flow toward the FRL, in an (POPE) feeding the future resected liver. POPE was perattempt to achieve hypertrophy. The redistribution was formed in 31 patients, under fluoroscopic guidance, via achieved with preoperative portal vein embolization (POPE), a percutaneous access. POPE was well tolerated and surto increase the volume of an initially insufficient FRL and gery was practicable in 24 patients without severe postthus to widen the possibilities of curative resection. operative liver failure. Seven operations were cancelled, but only one due to insufficient hypertrophy of the FRL.
PATIENTS AND METHODS
FRL volume values were 90 to 560 mL (mean 260 mL) before POPE and 160-783 mL (mean 443 mL) after POPE,