Right trisegment portal vein embolization for biliary tract carcinoma: Technique and clinical utility

M. Nagino et al., Right trisegment portal vein embolization for biliary tract carcinoma: Technique and clinical utility, SURGERY, 127(2), 2000, pp. 155-160
Citations number
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
ISSN journal
0039-6060 → ACNP
Year of publication
155 - 160
SICI code
Background. Right portal vein embolization has become popular in preparatio n for right hepatic lobectomy. However, right trisegment portal vein emboli zation (R3PE) is not well established. Methods. We performed R3PE in 15 patients with biliary tract carcinoma and 1 patient with primary sclerosing cholangitis. We used 2 types of 5.5F trip le-lumen balloon catheters to embolize portal branches of the right trisegm ent (the left medial, the right anterior, and the right posterior segments) . Results. R3PE was successful in all patients without any complications. The calculated volume of the right lobe significantly (P < .01) decreased from 650 +/- 161 cm(3) before embolization to 585 +/- 143 cm(3) after embolizat ion; the volume of the left lateral segment significantly (P < .0005) incre ased from 240 +/- 58 cm(3) to 361 +/- 68 cm(3). The volume of the left medi al segment was unchanged. The volume gain of th left lateral segment was la rger in patients with R3PE than in those patients (n = 41) with right porta l vein embolization (122 +/- 39 cm(3) vs 66 +/- 35 cm(3); P < .0001). Two o f the 16 patients underwent only laparotomy because of peritoneal dissemina tion, and the remaining 14 patients underwent right hepatic trisegmentectom y with caudate lobectomy. In addition, portal vein resection was also perfo rmed in 5 patients, and pancreatoduodenectomy and right hemicolectomy was p erformed in 3 patients. One patient died of posthepatectomy liver failure 8 7 days after surgery a mortality rate of 7.1 % (1/14 patients). Conclusions. R3PE is more useful than standard right portal vein embolizati on in preparation for right hepatic trisegmentectomy and has the potential to increase the safety of this high-risk surgery for patients with biliary tract carcinoma.