for patients who undergo curative resection. 6 Unfortunately, To render hepatectomy feasible in patients with an the percentage of patients likely to benefit from hepatic resecinitially deficient volume of the future remnant liver tion ranges from 5% 7 to 10% 8 in patients with adenocarci-(FRL), we redistributed portal blood flow rich in hepatonoma of the colon. trophic substances toward the FRL. Redistribution was As portal vein blood flow has hepatotrophic properties, 9 we achieved with preoperative portal vein embolization decided to reroute portal blood flow toward the FRL, in an (POPE) feeding the future resected liver. POPE was perattempt to achieve hypertrophy. The redistribution was formed in 31 patients, under fluoroscopic guidance, via achieved with preoperative portal vein embolization (POPE), a percutaneous access. POPE was well tolerated and surto increase the volume of an initially insufficient FRL and gery was practicable in 24 patients without severe postthus to widen the possibilities of curative resection. operative liver failure. Seven operations were cancelled, but only one due to insufficient hypertrophy of the FRL.
PATIENTS AND METHODSFRL volume values were 90 to 560 mL (mean 260 mL) before POPE and 160-783 mL (mean 443 mL) after POPE, From September 1989 to June 1995, we undertook a study of which represents a median increase of 79% { 50%. Hy-31 consecutive POPEs in 31 patients with tumor involving the pertrophy of the FRL was 90% { 52% after 30 days with liver. There were 18 men and 13 women, 16-78 years old (mean 58 years old). Of these 31 patients 22 had metastases from colorectal cyanoacrylate, 53% { 6% after 43 days with Gelfoam, and (mean 26 months), disease-free survival was 0-60 months Twenty-six patients had multiple lesions, and 5 had a single bulky (mean 19 months), and 7 patients are disease-free and lesion. Six patients had benefited from hepatic artery infusion alive 14 to 60 months (mean 43 months) after surgery. chemotherapy (3-20 courses, mean 9), whereas 10 others had had Although exclusively applicable in a limited subset of systemic chemotherapy. In all patients computed tomography durpatients, POPE widens the possibilities of curative hepa-ing arterial portography showed extensive involvement of the liver 11 below 10% at 15 minutes), the FRL volliver failure. 3 The successful resection of liver tumors is there-ume was below the acceptable limit of 25% of the complete liver fore dependent on the volume of the future remnant liver volume. In 7 patients with an altered indocyanine green test and/ (FRL). In clinical practice, this can occur (1) when there is a or who had received previous intra-arterial chemotherapy, the small left lobe and an extended right hepatectomy is manda-FRL volume was below 33% of the complete liver volume.The portal vein was accessed, via a subxyphoid route, under sonotory and (2) when major liver surgery is necessary in patients graphic and fluoroscopic guidance, by percutaneous placement of a with impaired liver function secondary to cirrhosis...
