Portal vein embolization with n-butyl-cyanoacrylate through an ipsilateral approach before major hepatectomy: single center analysis of 50 consecutive patients.

PURPOSE: To evaluate the efficacy of portal vein embolization (PVE) with n-Butyl-cyanoacrylate (NBCA) through an ipsilateral approach before major hepatectomy. Secondary end-points were PVE safety, liver resection and patient outcome. METHODS: Over a 5-year period 50 non-cirrhotic consecutive patients were included with primary or secondary liver cancer treatable by hepatectomy with a liver remnant (FLR) volume less than 25% or less than 40% in diseased livers. RESULTS: There were 37 men and 13 women with a mean age of 57 years. Colorectal liver metastases were the most frequent tumor and patients were previously exposed to chemotherapy. FLR increased from 422 ml to 629 ml (P < 0.001) after PVE, corresponding to anincrease of 52%. The FLR ratio increased from 29.6% to 42.3% (P < 0.001). Kinetic growth rate was 2.98%/week. A negative association was observed between increase in the FLR and FLR ratio and FLR volume before PVE (P = 0.002). In 31 patients hepatectomy was accomplished and only one patient presented with liver insufficiency within 30 days after surgery. CONCLUSIONS: PVE with NBCA through an ipsilateral puncture is effective before major hepatectomy. Meticulous attention is needed especially near the end of the embolization procedure to avoid complications. TRIAL REGISTRATION: Clinical Study ISRCTN registration number: ISRCTN39855523 . Registered March 13th 2017.

Drenagem percutânea de abscesso hepático piogênico multiloculado: relato de caso / Percutaneous drainage of a multiloculated pyogenic liver abscess: a case report

Os grandes abscessos hepáticos freqüentemen¡te necessitam de tratamento imediato pela asso¡ciação da antibioticoterapia com a drenagem da lesão. Existem duas principais alternativas de dre¡nagem: a percutânea e a cirúrgica aberta. A lite¡ratura estudada não estabelece um consenso em relação à terapêutica mais adequada. No entan¡to, há relatos de que grandes abscessos, espe¡cialmente se multiloculados ou os que contêm secreção purulenta espessa, estão inclinados ao insucesso quando tratados pela via percutânea. Neste relato de caso, os autores apresentam pa¡ciente com sinais de sepse, com volumoso abs¡cesso hepático piogênico, multisseptado, trata¡da com drenagem por via percutânea associada à antibioticoterapia sistêmica e com evolução favorável. O artigo foi submetido e aprovado pelo Comitê de Ética em Pesquisa da Rede Labs D'Or.