Five Cases Treated by Preoperative Percutaneous Transhepatic Portal Embolization with Dehydrated Ethanol

Takahito Nakagawa, Yoshie Une, Kazuhiro Ogasawara, Kazuhito Misawa, Toshiya Kamiyama, Tsuyoshi Shimamura, Tsunetake Hata, Tsutomu Haneda, Yasuaki Nakajima, Michiaki Matsushita, Naoki Sato, Junichi Uchino

First Department of Surgery, Hokkaido University School of Medicine

For the last 4 years, we have been carrying out preoperative percutaneous transhepatic portal embolization (PTPE) with dehydrated ethanol in 5 patients who had unresectable hepatocellular carcinoma (HCC). They underwent right hepatectomy after PTPE for the right portal vein. The mean volume of the left lobe had increased from 348.4 ± 120.3 to 563.0 ± 149.6 cm³ 2 weeks after PTPE, and to 675.0 ± 173.1 cm³ 4 weeks after PTPE. The mean volume of the embolized right lobe had decreased from 912.0 ± 329.6 cm³ to 841.0 ± 261.9 cm³ 2 weeks after PTPE, further to 668.0 ± 350.1cm³ 4 weeks after PTPE. When the dose of the injected dehydrated ethanol exceeded 20 ml, the hepatic necrosis was widespread, with a concomitant increase in the serum ALT level. Four weeks after PTPE with higher dose ethanol, the volume of the right lobe had decreased to 57 ± 23%, whereas, that of the left lobe had increased to 249 ± 80%. Histopathologically, the cells of the embolized right lobe were eosinophilic in H-E staining, and the left lobe hepatocytes were bright and contained many secretion granules. We suggest that PTPE with dehydrated ethanol may extend the indications for liver resection for HCC because of its favorable effect on the future residual liver volume.

Key words
percutaneous transhepatic portal embolization, hepatocellula carcinoma, dehydrated ethanol

Reprint requests
Takahito Nakagawa First Department of Surgery, Hokkaido University School of Medicine
N15 W7, Kita-ku, Sapporo, 060 JAPAN

Accepted
April 5, 1995

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