Simultaneous Dual Hepatic Vascular Embolization (DHVE) for Massive Hepatectomy

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology
• Surgical Oncology

Background:

• Simultaneous dual hepatic vein embolization (DHVE) is a technique proposed for safe right-side massive hepatectomy.
• DHVE has shown comparable liver hypertrophy results to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).

Observation:

• A patient with unresectable intrahepatic cholangiocarcinoma underwent neoadjuvant chemotherapy, leading to tumor shrinkage.
• The patient's future liver remnant (FLR) was initially 29.6% before simultaneous DHVE.
• Following DHVE, significant atrophy of the right lobe and hypertrophy of the left lobe were observed, increasing FLR to 40.2%.

Findings:

• Simultaneous DHVE was performed using transhepatic and transjugular approaches to embolize hepatic veins.
• The procedure resulted in a substantial increase in FLR volume, from 363 ml to 485 ml.
• Right trisectionectomy with vena cava resection was successfully performed three weeks after DHVE.

Implications:

• Simultaneous DHVE is an effective method for increasing FLR safely.
• This technique can facilitate extensive hepatectomy in complex liver cancer cases.
• The described technique offers a viable option for achieving complete tumor resection and improving patient outcomes.