Safety and outcomes of pre-operative portal vein embolization using N-butyl cyanoacrylate (Glue) in hepatobiliary malignancies: A single center retrospective analysis

Abstract

Aims and Objectives: To evaluate the outcome of preoperative portal vein embolization (PVE) using N-butyl cyanoacrylate (NBCA) for change in future liver remnant (FLR) volume, biochemical changes, and procedure-related complications. The factors affecting FLR hypertrophy and the rate of resection was also evaluated for this cohort. Materials and Methods: From 2012 to 2017, PVE utilizing NBCA mixed with lipiodol (1:4) was performed using percutaneous approach in 28 patients with hepatobiliary malignancies with low FLR. All patients underwent volumetric computed tomography (CT) assessment before and at 3–5 weeks after PVE and total liver volume (TLV), FLR volume, and FLR/TLV ratio, changes in portal vein diameter and factors affecting FLR were evaluated. Complications and the resectability rate were recorded and analyzed. Result: PVE was successful in all 28 patients. The mean FLR increased by 52% ± 32% after PVE (P < 0.0001). The FLR/TLV ratio was increased by 14.2% ± 2.8% (P < 0.001). Two major complications were encountered without any impact on surgery. There was no significant change seen in liver function test and complete blood counts after PVE. Eighteen patients (64.28%) underwent hepatic resection without any liver failure, and only three patients developed major complication after surgery. Remaining ten patients did not undergo surgery because of extrahepatic metastasis detected either on follow-up imaging or staging laparotomy. Patients with diabetes showed a lower rate of hypertrophy (P < 0.05). Conclusion: Preoperative PVE with NBCA is safe and effective for increasing FLR volume in patients of all age group and even in patients with an underlying liver parenchymal disease with hepatobiliary malignancy. Lesser hypertrophy was noted in patients with diabetes. A reasonable resectability was achieved despite having a high rejection in gall bladder cancer subgroup due to rapid disease progression.

Keywords

Future liver remnant - N-butyl cyanoacrylate glue - Portal vein embolization

Publikationsverlauf

Artikel online veröffentlicht:
23. Juli 2021

• References

• 1 Zhou XD, Tang ZY, Yu YQ, Yang BH, Lin ZY, Lu JZ. et al. Long-term survivors after resection for primary liver cancer. Clinical analysis of 19 patients surviving more than ten years. Cancer 1989; 63: 2201-6
• 2 Bakalakos EA, Kim JA, Young DC, Martin Jr EW. Determinants of survivalfollowing hepatic resection for metastatic colorectal cancer. World J Surg 1998; 22: 399-404
• 3 Fazakas J, Mándli T, Ther G, Arkossy M, Pap S, Füle B. et al. Evaluation of liver function for hepatic resection. Transplant Proc 2006; 38: 798-800
• 4 Abulkhir A, Limongelli P, Healey AJ, Damrah O, Tait P, Jackson J. et al. Preoperative portal vein embolization for major liver resection: Ameta-analysis. Ann Surg 2008; 247: 49-57
• 5 Lee KC, Kinoshita H, Hirohashi K, Kubo S, Iwasa R. Extension of surgical indications for hepatocellular carcinoma by portal vein embolization. World J Surg 1993; 17: 109-15
• 6 de Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V. Preoperative portal vein embolization for extension of hepatectomy indications. Hepatology 1996; 24: 1386-91
• 7 Imamura H, Shimada R, Kubota M, Matsuyama Y, Nakayama A, Miyagawa S. et al. Preoperative portal vein embolization: An audit of 84 patients. Hepatology 1999; 29: 1099-105
• 8 Abdalla EK, Hicks ME, Vauthey JN. Portal vein embolization: Rationale, technique and future prospects. Br J Surg 2001; 88: 165-75
• 9 Madoff DC, Abdalla EK, Vauthey JN. Portal vein embolization in preparation for major hepatic resection: Evolution of a new standard of care. J Vasc Interv Radiol 2005; 16: 779-90
• 10 Giraudo G, Greget M, Oussoultzoglou E, Rosso E, Bachellier P, Jaeck D. Preoperative contralateral portal vein embolization before major hepatic resection is a safe and efficient procedure: Alarge single institution experience. Surgery 2008; 143: 476-82
• 11 Cotroneo AR, Innocenti P, Marano G, Legnini M, Iezzi R. Pre-hepatectomy portal vein embolization: Single center experience. Eur J Surg Oncol 2009; 35: 71-8
• 12 van Lienden KP, van den Esschert JW, de Graaf W, Bipat S, Lameris JS, van Gulik TM. et al. Portal vein embolization before liver resection: Asystematic review. Cardiovasc Intervent Radiol 2013; 36: 25-34
• 13 Glantzounis GK, Tokidis E, Basourakos SP, Ntzani EE, Lianos GD, Pentheroudakis G. The role of portal vein embolization in the surgical management of primary hepatobiliary cancers. A systematic review. Eur J Surg Oncol 2017; 43: 32-41
• 14 van den Esschert JW, van Lienden KP, Alles LK, van Wijk AC, Heger M, Roelofs JJ. et al. Liver regeneration after portal vein embolization using absorbable and permanent embolization materials in a rabbit model. Ann Surg 2012; 255: 311-8
• 15 de Baere T, Denys A, Paradis V. Comparison of four embolic materials for portal vein embolization: Experimental study in pigs. Eur Radiol 2009; 19: 1435-42
• 16 Igami T, Ebata T, Yokoyama Y, Sugawara G, Takahashi Y, Nagino M. Portal vein embolization using absolute ethanol: Evaluation of its safety and efficacy. J Hepatobiliary Pancreat Sci 2014; 21: 676-81
• 17 Madoff DC. Portal vein embolization: The continued search for the ideal embolic agent. J Vasc Interv Radiol 2014; 25: 1053-5
• 18 Denys A, Lacombe C, Schneider F, Madoff DC, Doenz F, Qanadli SD. et al. Portal vein embolization with N-butyl cyanoacrylate before partial hepatectomy in patients with hepatocellular carcinoma and underlying cirrhosis or advanced fibrosis. J Vasc Interv Radiol 2005; 16: 1667-74
• 19 Tsoumakidou G, Theocharis S, Ptohis N, Alexopoulou E, Mantziaras G, Kelekis NL. et al. Liver hypertrophy after percutaneous portal vein embolization: Comparison of N-butyl-2-cyanocrylate versus sodium acrylate-vinyl alcohol copolymer particles in a swine model. Cardiovasc Intervent Radiol 2011; 34: 1042-9
• 20 Guiu B, Bize P, Gunthern D, Demartines N, Halkic N, Denys A. Portal vein embolization before right hepatectomy: Improved results using n-butyl-cyanoacrylate compared to microparticles plus coils. Cardiovasc Intervent Radiol 2013; 36: 1306-12
• 21 Jaberi A, Toor SS, Rajan DK, Mironov O, Kachura JR, Cleary SP. et al. Comparison of clinical outcomes following glue versus polyvinyl alcohol portal vein embolization for hypertrophy of the future liver remnant prior to right hepatectomy. J Vasc Interv Radiol 2016; 27: 1897-905.e1
• 22 Wajswol E, Jazmati T, Contractor S, Kumar A. Portal vein embolization utilizing N-butyl cyanoacrylate for contralateral lobe hypertrophy prior to liver resection: A systematic review and meta-analysis. Cardiovasc Intervent Radiol 2018; 41: 1302-12
• 23 Luz JHM, Luz PM, Bilhim T, Martin HS, Gouveia HR, Coimbra É. et al. Portal vein embolization with n-butyl-cyanoacrylate through an ipsilateral approach before major hepatectomy: Single center analysis of 50 consecutive patients. Cancer Imaging 2017; 17: 25
• 24 Broering DC, Millert C, Krupski G, Fischer L, Mueller L, Achilles EG. et al. Portal vein embolization vs portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg 2002; 6: 905-13
• 25 Di Stefano DR, de Baere T, Denys A, Hakime A, Gorin G, Gillet M. et al. Preoperative percutaneous portal vein embolization: Evaluation of adverse events in 188 patients. Radiology 2005; 234: 625-30
• 26 van Gulik TM, van den Esschert JW, de Graaf W, van Lienden KP, Busch OR, Heger M. et al. Controversies in the use of portal vein embolization. Dig Surg 2008; 25: 436-44
• 27 Nanashima A, Sumida Y, Shibasaki S, Takeshita H, Hidaka S, Sawai T. et al. Parameters associated with changes in liver volume in patients undergoing portal vein embolization. J Surg Res 2006; 133: 95-101