Right Hepatectomy in a Patient with Hepatocellular Carcinoma after Induction of Hepatic Parenchymal Atrophy through Subsequent Portal and Hepatic Vein Embolizations

Shin Hwang

doi:10.4166/kjg.2011.58.3.162

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Hwang: Right Hepatectomy in a Patient with Hepatocellular Carcinoma after Induction of Hepatic Parenchymal Atrophy through Subsequent Portal and Hepatic Vein Embolizations

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Korean J Gastroenterol 2011;58(3):162-165.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.3.162

Right Hepatectomy in a Patient with Hepatocellular Carcinoma after Induction of Hepatic Parenchymal Atrophy through Subsequent Portal and Hepatic Vein Embolizations

Shin Hwang

Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: Shin Hwang, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3930, Fax: +82-2-474-9027, E-mail: shwang@amc.seoul.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

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2. Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997; 26:1176–1181.

3. Yokoyama Y, Nagino M, Nimura Y. Mechanisms of hepatic regeneration following portal vein embolization and partial hepatectomy: a review. World J Surg. 2007; 31:367–374.

4. Hwang S, Lee SG, Ko GY, et al. Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg. 2009; 249:608–616.

5. Ko GY, Hwang S, Sung KB, Gwon DI, Lee SG. Interventional oncology: new options for interstitial treatments and intravascular approaches: right hepatic vein embolization after right portal vein embolization for inducing hypertrophy of the future liver remnant. J Hepatobiliary Pancreat Sci. 2010; 17:410–412.

6. Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006; 243:364–372.

7. Hwang S, Lee SG, Sung KB, Lee YJ. Hepatectomy for patients with transient hepatic failure after preoperative portal vein embolization. Hepatogastroenterology. 2007; 54:1817–1820.

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Fig. 1.

Initial application of transarterial chemoembolization. (A) Hepatic arteriogrphy shows a large-sized hypervascular mass at the right liver. (B) Two weeks after embolization, CT showed extensive tumor necrosis but incomplete lipiodol uptake, implica-ting presence of viable tumor cells.

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Fig. 2.

Preoperative right portal vein embolization. (A) The portal vein system was visualized through percutaneous ipsilateral approach. (B) After occlusion of the right portal vein with multiple coils and gelfoam, only the left portal vein was visualized.

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Fig. 3.

Subsequent right hepatic vein embolization following right portal vein embolization. (A) The right hepatic vein was visualized through transjugular approach. (B) The right hepatic vein was occluded with multiple coils and a vascular plug (arrow).

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Fig. 4.

Computed tomography images following right portal and hepatic vein embolizations. (A) There were little hemi-liver volume changes 2 weeks after hepatic vein embolization. (B) A slight further atrophy of the right liver was found 2 months after hepatic vein embolization.

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Fig. 5.

Computed tomography images before and after right hepatectomy. (A) Marked atrophy of the right liver was found at the 15 months after hepatic vein embolization. (B) CT taken 1 week after surgery showed prominent regeneration of the remnant left liver.

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Fig. 6.

Gross finding of the resected right liver specimen. The hepatocellular carcinoma was nearly completely necrotic due to repeated chemoembolization, with background cirrhosis of mixed micro-and macro-nodular type.

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