Apport de la radiologie interventionnelle dans le traitement des métastases hépatiques des cancers colorectaux (Embolisation portale pré-opératoire - Radiofréquence percutanée)

Selective embolization of portal branches of some liver segments will induce hypertrophy of non embolized segments of the liver. This induced hypertrophy allows to perform hepatectomy in patients with initially insufficient volume of future remnant liver (FRL). This technique aims at patient with initial FRL volume below 25 % of total liver volume, and to patient with initial FRL volume below 40 % of total liver volume when a diffuse liver disease is present. The mean hypertrophy obtained 1 month after pre-operative portal vein embolization (POPE) was 82 ± 56 % in our experience. Post operating complications and long term survival for patient operating after POPE is not different from patient operated with a classical hepatectomy. Radiofrequency is able to destroy hepatic tumors after insertion of a needle electrode inside the tumor under imaging guidance. Thermocoagulation of the targeted tissue is obtained after emission of a 400 to 500 KHz alternative able to induce frictional heating in the neighboring of the electrode. Spreading of this technique is at least partially explained by a relative high local efficacy (90 % of small tumor targeted can be destroyed) and a low invasiveness. However, today no benefit in survival has been demonstrated for patients treated with radiofrequency ablation of liver tumors. Consequently, this technique should not be proposed to tumors that can be surgically resected.