J.Jpn. Surg. Soc.. 101(5): 404-407, 2000

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Feature topic

PREOPERATIVE PORTAL EMBOLIZATION FOR HILAR BILE DUCT CARCINOMA

When extensive resection of normally functioning parenchyma such as in extended right lobectomy, right trisegmentectomy, or left trisegmentectomy is performed for hilar bile duct carcinoma, the procedure carries a considerable risk of postoperative hepatic failure. A technique (embolization of the portal venous branches in the liver to be resected) has been used with satisfactory results and a low incidence of postoperative hepatic failure after extensive resection of normally functioning parenchyma. The detailed mechanisms of volume reduction induced by portal venous flow occlusion and hypertrophy of the counterpart lobe have not yet been clarified but similar results have beeri observed in many animal experiments and clinical cases. Two techniques are used for embolization of the portal venous branches:the percutaneous transhepatic route and the translleocolic route. Fibrin glue, ethanol, gelatin sponge, and cyanoacrylate are used for embolization and the degree of compensated hypertrophy of the non embolized lobe is influenced mainly by the agents used for embolization.

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