Percutaneous transhepatic portography in pancreatobiliary carcinoma: Evaluation of resectability

Abstract

Direct portography using the percutaneous, transhepatic approach provides a rapid and accurate visualization of the portal, splenic, and superior mesenteric veins. In 7 patients with a malignant tumor of the pancreatobiliary region and in 1 patient with pancreatitis, the method was reliable in predicting resectability of the lesion.Pancreatic carcinoma is responsible for an increasing number of deaths. With the more widespread use of pancreatic imaging techniques such as computed tomography, ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), and superselective angiography, and the use of fine needle biopsy for cytologic diagnosis, it can be expected that pancreatic tumors will be diagnosed in earlier stages of growth.Although a radical operation for a large tumor was barely possible in the past, the diagnosis of smaller tumors at present poses the problem of patient selection for surgery. A reliable determination of operability could save the patient from unnecessary surgery, and decrease the time and costs of hospitalization. Alternative palliative and therapeutic measures such as endoscopic or transhepatic biliary drainage, radiation and/or chemotherapy, could be instituted earlier. As the venous structures in the pancreatobiliary region (portal, splenic, and superior mesenteric veins) are critical in surgery, and veins in general show infiltration by tumor earlier and more frequently than arteries, we performed percutaneous transhepatic portography to evaluate operability in 8 patients suspected of having a pancreatobiliary tumor. Material and MethodsDuring 1980 and 1981, 8 patients with histologically confirmed or clinically suspected malignant tumors of the pancreatobiliary region were examined with percutaneous transhepatic portography (PTP). The technique of PTP was in accordance with that described in the literature [1, 2], i.e., a right-sided puncture through the liver under local anesthesia and placement of a catheter in the portal vein and its extrahepatic tributaries (splenic vein and superior mesenteric vein).Contrast medium (40 ml Angiografine 65%) was injected in the splenic and superior mesenteric veins at a rate of 8 ml/sec; 12 films were exposed in both frontal and lateral views at a rate of 1 film/sec. In 1 patient, the puncture was not readily successful. Selective angiography of the superior mesenteric artery was performed to localize the portal vein and to exclude portal vein thrombosis. Subsequent portal vein puncture then was successful. Obstructive jaundice was present in 5 patients. Percutaneous transhepatic biliary drainage was performed in 2 patients several days before PTP, and in 1 patient immediately before PTP.Two patients had surgical internal biliary drainage established at another hospital before referral for further treatment. One of these patients still had dilated intra-and extrahepatic bile ducts that were entered accidentally during the puncture attempts for portography. After the investigation, this patient complained of abdominal pain, and a short-lasting ...

Most Informative Projection for Portography: Quantitative Analysis of 47 Percutaneous Transhepatic Portograms

“…Percutaneous transhepatic portography is safe, easy to perform, and capable of producing high-quality images. Despite the invasive nature of the procedure, this modality is valuable for detailed and accurate preoperative evaluation of the portal venous system [5,8,9]. In the future, however, advances in technology will offer high-quality three-dimensional images by multislice helical CT, which will surpass PTP.…”