New possibilities for major liver surgery in patients with Klatskin tumors or primary hepatocellular carcinoma--an old problem revisited.

An impaired liver function secondary to liver disease is considered a contra-indication for extensive liver resection because of the risk of liver failure. Selective embolization of the portal branch corresponding to the part of the liver that is considered for resection, carried out three to four weeks before surgery, reportedly induced atrophy of the embolized part of the liver with hypertrophy of the nonembolized part. This policy showed satisfactory early results in 46 patients who had extended liver resection. One patient with severe cholangitis died in the first 30 days. Seven patients had minor complications, which responded well to conservative management (subphrenic abscesses 3, wound infections 3, pulmonary infection 1). Selective portal embolization was well tolerated and was associated with temporary mild side effects. Liver functions before and after embolization returned to pre-embolization values. The present results support the policy of selective portal embolization in patients with impaired liver function in whom extensive liver resection is necessary. Embolization is a promising ancillary preoperative alternative.