Selective portal vein embolization with absolute ethanol induces hepatic hypertrophy and makes more extensive hepatectomy possible
✍ Scribed by K Ogasawara; J Uchino; Y Une; Y Fujioka
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Weight
- 786 KB
- Volume
- 23
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
Patients with hepatocellular carcinoma (HCC) are
Portal vein embolization has been used recently to decrease the amount of the liver to be resected and to usually affected by chronic hepatitis or cirrhosis. [1][2][3] enhance the function of the remaining hypertrophied Postoperative hepatic failure after an extensive hepatic lobes. We have observed a strong contact destructivity resection for HCC is a serious complication in patients of absolute ethanol and used it for portal vein embolizawith a cirrhotic or fibrotic liver. It has been reported tion. The present study was performed to produce hethat occlusion of portal vein branches by ligation or empatic hypertrophy and to show histopathologic changes bolization leads to atrophy of the affected lobes of the that follow ethanol embolization of rat liver. Hepatic liver and hypertrophy of the unaffected lobes. 4,5 These proliferation and histopathology were studied in rats changes are proportional to the volume of affected liver receiving low and high doses of absolute ethanol via porparenchyma. If the atrophic lobes are resected after the tal vein and rats undergoing 70% hepatectomy alone.
remaining liver hypertrophies, the decreased amount of
The liver weight of the unresected and unembolized liver to be resected may be advantageous to keep the lobes increased rapidly after embolization and hepatectomy. Although the increase was more rapid in the high-liver functioning postoperatively.
dose group than the low-dose group in early days, the After Lunderquist et al 6 developed a method for perfinal results were not different from each other and were cutaneous transhepatic access to the portal vein, percualmost equal to those after hepatectomy. Complete obtaneous transhepatic portography (PTP) has become a struction of portal venous branches and massive necrocommon technique for the visualization of the portal sis were the main histopathologic observations after venous system. Kinoshita et al 7 used percutaneous portal vein embolization with all doses of ethanol. Betranshepatic portal embolization (PTPE) to induce cause the mortality rate in the low-dose group was lower compensatory hypertrophy in the unembolized hepatic than in the high-dose group and extensive necrosis of lobe. Recently, preoperative PTPE for the segments the liver parenchyma and subsequent regeneration was containing cancer has been used to reduce the proporsufficient, using minimum dose of ethanol was much tion of liver resected and to prevent postoperative liver safer. Based on the biochemical and hematologic parameters, portal vein embolization with low-dose ethanol failure. 8,9 Most investigators have used fibrin paste or did not impair liver function more than hepatectomy gelatin sponge fragments (Gelfoam; Upjohn, Kalamaalone during the initial 14 days. Portal vein embolization zoo, MI) as embolizing agents. [10][11][12] with absolute ethanol makes more extensive hepatec-Kaminou et al 13 have recently reported complete netomy possible by reducing the volume necessary to recrosis of liver tissue in the embolized segment consect and preserves the function of the remaining liver. taining the tumor after transportal absolute ethanol (HEPATOLOGY 1996;23:338-345.) injection in one patient. Absolute ethanol may have an advantage as an embolizing agent because of its strong contact destructivity. It will be diluted immediately and the systemic cytotoxicity is negligible. There have Abbreviations: BrdU, 5-bromo-2-deoxyuridine; LW, the whole liver weight; been no experimental studies on hepatic regeneration LWI, liver weight increase; PTP, percutaneous transhepatic portography; PTPE, percutaneous transhepatic portal embolization; PVE, portal vein embo-after portal vein embolization (PVE) with absolute ethlization; %LL, the percentage of the whole liver weight of the left median and anol. In this report, we investigated the regenerative the left lateral lobes.
response and histopathologic changes of the liver after