Safety and outcomes of pre-operative portal vein embolization using N-butyl cyanoacrylate (Glue) in hepatobiliary malignancies: A single center retrospective analysis

Abstract

Aims and Objectives: To evaluate the outcome of preoperative portal vein embolization (PVE) using N-butyl cyanoacrylate (NBCA) for change in future liver remnant (FLR) volume, biochemical changes, and procedure-related complications. The factors affecting FLR hypertrophy and the rate of resection was also evaluated for this cohort. Materials and Methods: From 2012 to 2017, PVE utilizing NBCA mixed with lipiodol (1:4) was performed using percutaneous approach in 28 patients with hepatobiliary malignancies with low FLR. All patients underwent volumetric computed tomography (CT) assessment before and at 3–5 weeks after PVE and total liver volume (TLV), FLR volume, and FLR/TLV ratio, changes in portal vein diameter and factors affecting FLR were evaluated. Complications and the resectability rate were recorded and analyzed. Result: PVE was successful in all 28 patients. The mean FLR increased by 52% ± 32% after PVE ( P < 0.0001). The FLR/TLV ratio was increased by 14.2% ± 2.8% ( P < 0.001). Two major complications were encountered without any impact on surgery. There was no significant change seen in liver function test and complete blood counts after PVE. Eighteen patients (64.28%) underwent hepatic resection without any liver failure, and only three patients developed major complication after surgery. Remaining ten patients did not undergo surgery because of extrahepatic metastasis detected either on follow-up imaging or staging laparotomy. Patients with diabetes showed a lower rate of hypertrophy ( P < 0.05). Conclusion: Preoperative PVE with NBCA is safe and effective for increasing FLR volume in patients of all age group and even in patients with an underlying liver parenchymal disease with hepatobiliary malignancy. Lesser hypertrophy was noted in patients with diabetes. A reasonable resectability was achieved despite having a high rejection in gall bladder cancer subgroup due to rapid disease progression.

Portal vein embolization with n-butyl-cyanoacrylate before hepatectomy: a single-center retrospective analysis of 46 consecutive patients

“…Furthermore, a recent study reports that PVE is not associated with increased postoperative complications (26). The mean FLR% volume increase varies between 38% in cohorts with varying embolic material (4) and 49%-52% when only NBCA as was used (6,27). This is consistent with the present study with a mean FLR% volume increase of 56%.…”

“…The mean FLR% volume increase varies between 38% in cohorts with varying embolic material (4) and 49%–52% when only NBCA as was used (6,27). This is consistent with the present study with a mean FLR% volume increase of 56%.…”

Portal Vein Embolization: Rationale, Techniques, and Outcomes to Maximize Remnant Liver Hypertrophy with a Focus on Contemporary Strategies

“…Mukund et al assessed PVE with nBCA glue and lipiodol in 28 patients [ 39 ]. The mean absolute FLR volume increased from 371 mL ± 87 to 567 mL ± 142, with a mean percentage increase of 52% ± 32 ( p <0.0001).…”

Glue or Onyx: A Guide to Choice – Tips and Techniques

“…Cyanoacrylate is a highly adaptable adhesive and can be used in a wide variety of endovascular procedures: peripheral and gastrointestinal embolization (even in the presence of coagulopathies; Figure 5), arteriovenous vascular malformations (Figure 6), type-II endoleak embolization of aortic aneurysms, treatment of venous district conditions (esophageal varices, portal vein embolization), oncological treatment (both palliative and preoperative), and bronchial artery embolization for the treatment of hemoptysis [12,15,18,20,21,[25][26][27][28][29].…”