Initially unresectable hilar cholangiocarcinoma: hepatic regeneration after transarterial embolization

To assess with volumetric computed tomography (CT) the pattern and extent of hepatic regeneration induced with transarterial embolization of initially unresectable hilar cholangiocarcinoma (Klatskin tumor).

In this prospective study, 13 patients (four men, nine women) with hilar cholangiocarcinoma, aged 43-74 years (mean +/- 1 standard deviation, 59.9 years +/- 9.6), underwent preoperative embolization of the right hepatic lobe. Embolization was performed transarterially by using four to 15 embolization coils. Volumetric measurements of the entire liver, left hepatic lobe, and spleen were performed with contrast material-enhanced and unenhanced helical CT before and after embolization in all patients.

After right lobe embolization, volumetric helical CT measurements revealed a 2%-33% decrease (mean, 10%) in the volume of the affected right hepatic lobe, an 11%-68% increase (mean, 37%) in the volume of left hepatic lobe parenchyma, and variations in splenic volume of -5% to +28% (mean, +11%). Nine patients underwent extended hepatectomy 27-75 days (mean, 44 days) after embolization. No patient had severe complications due to embolization.

In patients with an initially unresectable bilateral Klatskin tumor, right lobar arterial coil embolization results in enlargement of the left hepatic lobe (as verified with volumetric helical CT), thus allowing right hemihepatectomy.