T. Cabrera

Implanting Metal Fiducials to Guide Stereotactic Liver Radiation: McGill Experience and Review of Current Devices, Techniques and Complications:

In this work we report our technique and outcomes placing percutaneous liver fiducials, summarize the literature on the risks of this procedure and present the various fiducials available today. Thirty-nine subjects, 27 males and 12 females who had received liver fiducial implants between November 2006 and September 2010 were retrospectively studied. Eighty-five gold cylinders (15%) and platinum coils (85%) were inserted under computed tomography (CT) guidance. All fiducials placed proved adequate to proceed with radiation image guidance. With one notable exception of gross migration, fiducials were inserted without serious complications. Although fiducial implantation in the liver has proven successful, the procedure does carry a variety of risks.

Portal Vein Embolization in the Setting of Staged Hepatectomy with Preservation of Segment IV ± I Only for Bilobar Colorectal Liver Metastases: Safety, Efficacy, and Clinical Outcomes

PURPOSE To assess frequency of adverse events, efficacy, and clinical outcomes of percutaneous portal vein embolization (PVE) in patients with bilobar colorectal liver metastases undergoing staged hepatectomy with preservation of segment IV ± I only. MATERIALS AND METHODS Retrospective analysis was performed of 40 consecutive patients who underwent right PVE after successful left lobectomy between 2005 and 2013. Rates of adverse events, future liver remnant (FLR) > 30% compared with baseline liver volume, clinical success (completion of staged hepatectomy with clearance of liver metastases), and overall survival were analyzed. RESULTS PVE was performed using polyvinyl alcohol particles (n = 7; 17.5%), particles plus coils (n = 23; 57.5%), and N-butyl cyanoacrylate glue plus ethiodized oil (n = 10; 25%). Technical success was 100%. After PVE, 20% (n = 8) of patients exhibited portal venous thrombosis, ranging from isolated intrahepatic portal branch thrombosis to massive thrombosis of the main portal vein (n = 3) and responsible for periportal cavernoma and portal hypertension in 5 patients. Of patients, 23 (57.5%) had FLR ≥ 30%, and 21 (52.5%) had clinical success. Six patients had significant stenosis or occlusion of the left portal vein or biliary system after original left lobectomy, which was independently associated with FLR < 30% (R2 = 0.24). Clinical success was the only independent variable associated with survival (R2 = 0.25). CONCLUSIONS PVE for staged hepatectomy with preservation of segment IV ± I only is technically feasible, leading to adequate hypertrophy and clinical success rates in these patients with poor oncologic prognosis. Portal venous thrombosis is greater after the procedure than in the setting of standard PVE.