Portal vein embolization: Present and future

Lauranne Piron (1) , Emmanuel Deshayes (2) , Laure Escal (1) , Regis Souche (1) , Astrid Herrero (3) , Marie-Ange Pierredon-Foulongne (1) , Eric Assenat (1) , Ngo Le Lam , François Quenet (2) , Boris Guiu (1, 4)

1 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
2 ICM - UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle
3 Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB)
4 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier

Portal vein embolization consists of occluding a part of the portal venous system in order to achieve the hypertrophy of the non-embolized liver segments. This technique is used during the preoperative period of major liver resection when the future remnant liver (FRL) volume is insufficient, exposing to postoperative liver failure, main cause of death after major hepatectomy. Portal vein embolization indication depends on the FRL, commonly assessed by its volume. Nowadays, FRL function evaluation seems more relevant and can be measured by 99mTc labelled mebrofenin scintigraphy. Portal vein embolization procedure is mostly performed with percutaneous trans-hepatic access by using ultrasonography guidance and consists of embolic agent injection, such as cyanoacrylate, in the targeted portal vein branches with fluoroscopic guidance. It is a safe and well-tolerated technique, with extremely low morbi-mortality. Portal vein embolization leads to sufficient FRL hypertrophy in about 80% of patients, allowing them to undergo surgery from which they were initially rejected. The two main reasons of non-resection are tumor progression (?15% of cases) and FRL insufficient hypertrophy (?5% of cases). When portal vein embolization is not enough to obtain adequate FRL regeneration, hepatic vein embolization may potentiate its effect (liver venous deprivation technique).

Mots clés: Humans; Liver Neoplasms; Middle Aged; Liver; Liver metastases; Chemotherapy; Adjuvant; Cyanoacrylates; Embolisation portale; Embolization; Therapeutic; Futur foie restant; Future remnant liver; Hepatectomy; Hepatocarcinoma; Hépatocarcinome; Hypertrophy; Imino Acids; Liver Failure; Liver Regeneration; Liver resection; Métastases hépatiques; Organotechnetium Compounds; Portal Vein; Portal vein embolization; Preoperative Care; Résection hépatique

Domaines: Sciences du Vivant [q-bio]

Lauranne Piron, Emmanuel Deshayes, Laure Escal, Regis Souche, Astrid Herrero, et al.. Portal vein embolization: Present and future. Bulletin du Cancer, 2017, 104 (5), pp.407--416. ⟨10.1016/j.bulcan.2017.03.009⟩. ⟨hal-01761876⟩