Recent advances in the treatment of hilar cholangiocarcinoma: portal vein embolization |
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Authors: | Yokoyama Yukihiro Nagino Masato Nishio Hideki Ebata Tomoki Igami Tsuyoshi Nimura Yuji |
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Institution: | (1) Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan |
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Abstract: | The clinical application of portal vein embolization (PVE) has contributed to improving the postoperative outcome of hilar
cholangiocarcinoma. The enlarged nonembolized lobe after PVE protects the patient from postoperative hepatic failure, due
to the increased functional reserve, and shortens the hospital stay. Although numerous reports have shown beneficial effects
of PVE on postoperative outcome after extended hepatectomy, no randomized controlled study has been performed so far. It is
urgent to establish a “gold standard” of PVE, because the indications, approach to the portal vein, types of embolic materials,
and methods used to evaluate the function of the future liver remnant are variable among institutions. The indications and
procedures of PVE for hilar cholangiocarcinoma may be different from those for hepatocellular carcinoma or colorectal metastasis,
because, in many patients with hilar cholangiocarcinoma, biliary cancer is associated with biliary obstruction and cholangitis.
This review article summarizes the contribution of PVE to the outcome of postoperative management in patients with hilar cholangiocarcinoma
needing extended hepatectomy. We also describe our PVE procedure, which has been established from our experience of more than
240 cases of biliary cancer. Furthermore, the drawbacks of PVE, which may reduce the pool of candidates for surgery, are also
discussed. |
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Keywords: | Extended hepatectomy Volumetry Indocyanine green clearance Future liver remnant Embolic materials |
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