Portal vein embolization leads to liver growth before resection of hamartoma

Last Updated: 2015-09-23

By Will Boggs MD

NEW YORK (Reuters Health) - Portal vein embolization produced liver growth prior to hepatic resection of a mesenchymal hamartoma in a toddler, according to a case report.

In adults, portal vein embolization induces hypertrophy of the future liver remnant before extended hepatectomy, thereby decreasing the risk of postoperative liver failure. This approach has not been reported before in children.

Dr. Sylvain Terraz from Swiss Center for Liver Diseases in Children, University Hospitals of Geneva, and colleagues performed portal vein embolization percutaneously in a 14-month-old toddler with a large multifocal mesenchymal hamartoma of the entire right liver.

Five weeks after embolization, the future liver remnant volume had increased from 104 mL to 216 mL, a gain of 108%, and now represented 42.6% of the overall liver volume.

In contrast, a nonembolized segment increased in volume by only 8% during the same interval, according to the report, online September 21 in Pediatrics.

After right hepatectomy, total bilirubin and factor V activity remained within normal ranges, and four years later the child was thriving and doing well.

Yearly Doppler ultrasound studies have shown normal liver parenchyma and normal flow of the hepatic vessels, without bile duct dilatation.

"Portal vein embolization is feasible in very young children when an extended liver resection is indicated," the authors conclude. "However, there is a need to develop appropriate (embolic) materials for pediatric patients, to warrant the safety profile of this procedure."

Dr. Uenis Tannuri from the University of São Paulo Medical School's Pediatric Surgery and Pediatric Liver Transplantation Division in Brazil has performed more than 650 pediatric liver transplants.

"Generally, I do not recommend this procedure previously to a hepatectomy," Dr. Tannuri, who is not linked to the new report, told Reuters Health by email.

"Hepatectomies for mesenchymal hamartomas may be easily performed, without complications. It is a benign tumor! Extended right hepatectomy is very easy to perform, with liver remnant of segments 2 and 3 and excellent postoperative liver function. You can resect up to 4/5 of liver parenchyma, without postoperative liver dysfunction," he said.

"In my opinion, this complex procedure (portal vein branch embolization) is feasible, although unnecessary," Dr. Tannuri concluded.

Dr. Sajid S. Qureshi from Tata Memorial Hospital's division of pediatric surgical oncology in Mumbai, India, told Reuters Health by email, "Portal vein embolization can be recommended in any age if there is a genuine indication to enhance the residual unaffected liver volume prior to extensive resection."

Like Dr. Tannuri, though, he noted that "children can withstand resection of their liver parenchyma. Hence, if one is confident of having a safe resection, it can be performed even in large tumors without portal vein embolization. Secondly, mesenchymal hamartomas are benign tumors and don't require aggressive resection; therefore, a conservative resection is advisable and is feasible in most instances if the vascular anatomy permits."

Dr. Terraz did not respond to a request for comments.

SOURCE: http://bit.ly/1NSW0MG

Pediatrics 2015.