L'embolisation portale préopératoire: Un moyen efficace pour hypertrophier le foie sain et élargir les indications des résections hépatiques

Aim of the study: The aim of the preoperative portal embolization is a redistribution of the portal venous blood flow in an attempt to induce hypertrophy of the future remnant liver in order to perform a curative liver resection. Material and methods: Preoperative portal embolization was performed in a group of 43 patients. The volumetric ratio (future remnant liver/total liver - tumor) was 20%. Liver metastases were present in 40 patients and primary liver tumor in three. Twenty-four patients had received chemotherapy prior to the preoperative portal embolization. Required operative procedures were right hepatectomy (n = 15), right hepatectomy extended to the segment IV (n = 24) or atypical resection (n = 4). Preoperative portal embolization was performed under percutaneous transhepatic approach with a Blue Histoacryl^® and Lipiodol Ultra Fluide^® mixture. Liver volumetric measurements were obtained with 3D color encoded computed tomography, before portal embolization and before surgery. Results: Hypertrophy of the future remnant liver was 83 ± 58% after a mean 32-day interval between portal embolization and surgery. The tolerance of portal embolization was excellent. Thirty-six hepatectomies were performed as initially planned; seven were cancelled for emergence of metastases (distant in six patients and intrahepatic in one). Conclusion: Pre-operative portal embolization is a safe and effective procedure which increases the possibilities of curative resection in the liver tumors.