Efficacy and Long-term impact of Preoperative Portal Vein Embolization with Dehydrated Ethanol in Patients with Primary Liver Cancer

Takahito Nakagawa, Michiaki Matsushita, Toshiya Kamiyama, Nobuaki Kurauchi, Tsuyoshi Shimamura, Naoki Sato, Yasuaki Nakajima, Tadashi Shimizu^* and Satoru Todo

First Department of Surgery, Department of Radiology^*, Hokkaido University School of Medicine

Background: Our previous data has shown that preoperative portal vein embolization (PVE) with dehydrated ethanol atrophies the embolized liver lobe and enlarges the presumptive residual liver. We assessed the efficacy of PVE with ethanol in patients with primary liver cancer and its impact on long-term outcome after hepatectomy.
Methods: We studied 14 patients who underwent PVE before operation. Of these, 12 were diagnosed with hepatocellular carcinoma (HCC), 1 with cholangiocellular carcinoma (CCC), and 1 with combined HCC and CCC. Standard right lobectomy or right trisegmentectomy was conducted in all patients. Laboratory data, liver volumetry before and after PVE, and prognosis were analyzed. To assess the impact of PVE on long-term outcome, 63 HCC patients treated by standard or extended right lobectomy without PVE were used as controls.
Results: The dose of injected dehydrated ethanol ranged from 10 to 35 ml (mean: 15.4 ml). Two of 5 receiving dehydrated ethanol exceeding 20 ml reduced platelet counts exceeding 50% of the initial value. The mean volume of presumptive remnant liver increased dramatically from 354±25 to 495±33 cm³ (145±12% vs. initial value, p<0.0005) in 2 weeks after PVE, decreasing the liver resection ratio from 67.9±2.4% to 54.1±2.8%. Cumulative survival of resected HCC patients after PVE was 100% at 1 year and 50% at 3 and 5 years. Disease-free survival was 87.5% at 1 year, 30% at 3 years, and 0% at 5 years, equivalent to those observed in patients who underwent hepatectomy without PVE.
Conclusions: These results show that preoperative PVE with dehydrated ethanol is a safe procedure that induces dramatic regulation in the presumptive residual liver, reducing the resection ratio. This is a promising strategy for improving the outcome primary liver cancer patients with by broadening the scope of those who can undergo major hepatic resection safely.

Key words
portal vein embolization, percutaneous transhepatic portal embolization, primary liver cancer, dehydrated (absolute) ethanol

Reprint requests
Takahito Nakagawa First Department of Surgery, Hokkaido University School of Medicine N-15, W-7, Kita-Ku, Sapporo, 060-8638 JAPAN

Accepted
December 19, 2000

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