Brief Clinical ReportsPortal embolization relieves persistent jaundice after complete biliary drainage*
Section snippets
Case report
An 81-year-old man was admitted in December 1996 for obstructive jaundice. His serum bilirubin level was 8.2 mg/dL. Biliary drainage was performed by using 3 catheters: to the right paramedian and lateral branches and to the left hepatic duct. A cholangiography (Fig 1) and abdominal computed tomography indicated the presence of a hilar bile duct carcinoma with predominant left duct involvement.
Discussion
PE is a radiologic technique causing atrophy in the embolized region and compensatory hypertrophy in the contralateral region of the liver.2 The technique is widely performed before hepatectomy to induce hypertrophy in the future remnant liver and increase the safety of an extensive hepatectomy.2 In the current case, this technique was applied to improve liver function. PE was performed to induce functional enhancement in the selected liver sector and relieve worsening jaundice.
Pathologic and
Conclusion
Recovery of liver function may be possible in some patients with persistent jaundice after biliary drainage. If the patient has a functional disparity among liver sectors, jaundice can be relieved by a PE that induces functional enhancement of a selected sector(s). Moreover, patients may subsequently be capable of undergoing radical operation. PE should be considered as an option in patients who have persistent or worsening jaundice after biliary drainage.
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Cited by (41)
Determination of Resectability
2016, Surgical Clinics of North America" Small-for-flow" syndrome: Shifting the " size" paradigm
2013, Medical HypothesesCitation Excerpt :These techniques, however, require considerable time in order to achieve the hypertrophy of the parenchyma, which significantly increases the period of time during which the patient is not receiving chemotherapy. Furthermore, these maneuvers are associated with stimulation of neoplastic cell growth in the non-embolized lobes, therefore requiring surgical treatment or physical destruction of such lesions prior to the embolization [50–52]. Another new strategy aiming for a faster increase of residual liver volume consists of performing the ligation of the portal vein and the hepatic transection in the same surgical act, preserving arterial vascularization.
Update on portal vein embolization: Evidence-based outcomes, controversies, and novel strategies
2013, Journal of Vascular and Interventional RadiologyPreoperative portal vein embolization: Rationale, indications, and results
2012, Blumgart's Surgery of the Liver, Biliary Tract and PancreasThe efficacy of portal vein embolization prior to right extended hemihepatectomy for hilar cholangiocellular carcinoma: A retrospective cohort study
2011, European Journal of Surgical OncologyCitation Excerpt :The rationale for portal vein embolization is based on data that indicate an increase in future liver remnant volume following embolization that is associated with an improvement in function. For example, biliary excretion in the postembolization future liver remnant increases,18,19 and the results of the liver function tests improve after portal vein embolization.7 Through radioreceptor imaging with technetium 99m galactosyl human serum albumin, Kudo et al20 showed an increase in asialoglycoprotein receptor binding sites in the postembolization future liver remnant before resection.
Uses and Limitations of Portal Vein Embolization for Improving Perioperative Outcomes in Hepatocellular Carcinoma
2010, Seminars in OncologyCitation Excerpt :Although met with much skepticism as to its utility early on, the literature has definitively shown that PVE correlates with increased function of the resulting hypertrophied FLR via manifold biochemical, functional, and radiographic analyses. These have included an increase in the percentage of ICG excretion of the FLR, an increase in bile flow and clearance, and an increase in technetium 99m 99mTc-GSA scintigraphy, supporting the shift and increase of function to the nonembolized lobe (FLR).40-42 The vast majority of literature regarding PVE and liver resection involves either formal right hepatectomy or extended right hepatectomy, as the right lobe of the liver comprises approximately 60% to 70% of the total liver volume, thus leaving a potentially smaller FLR volume.
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Reprint requests: Masatoshi Makuuchi, MD, PhD, Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.