Portal Vein Embolisation for Extended Hepatectomy: Single-centre Experience

Overview

Journal J Gastrointest Cancer

Publisher Springer

Specialties Gastroenterology
Oncology

Date 2011 Sep 28

PMID 21948270

Authors

Soumil Vyas

Clare Bent

Stefano Partelli

Ajit T Abraham

Robert R Hutchins

Satyajit Bhattacharya

Deborah Low

Tim Fotheringham

Hemant M Kocher

Affiliations

Soon will be listed here.

Abstract

Background: Portal vein embolisation (PVE) induces contra-lateral liver hypertrophy to facilitate an extended hepatectomy.

Aim: This paper aims to analyse our data on PVE and extended hepatectomy. Outcome measures included success of PVE, feasibility of resections, operative morbidity and survival.

Methods: A retrospective analysis of data collected prospectively on 33 patients (2004-2008) was performed. Survival curves were estimated by the Kaplan-Meier (Breslow) method. Significance was defined as p < 0.05.

Results: A total of 31 patients had successful PVE. There were 24 patients who underwent surgery. Significant hypertrophy of residual liver was noted from 230.15 (pre-embolisation) to 428.50 ml (post-embolisation) (median, p < 0.0001). A total of 16 patients had hepatectomy (14: R0; 2: R1) with a single mortality (6.25%) and 56.25% morbidity, and a median length of stay of 17 days. Median overall survival was 14 (95% CI 7.8-20.2) months. Patients who underwent resection had a median disease-specific survival of 33 (95% CI 4-62) months compared with 8.6 (95% CI 0-19.9) months for patients without resection (p = 0.14). For patients with primary hepato-biliary tumours, the median disease-specific survival was 7.9 (95% CI 4.5-11.3) months compared with a median survival of 19.7 (95% CI 0-42.2) months for patients with metastases (p = 0.07).

Conclusions: PVE is safe, facilitates R0 resection and offers the best chance of cure, especially for liver metastases.

References

Broering D, Hillert C, Krupski G, Fischer L, Mueller L, Achilles E . Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg. 2002; 6(6):905-13; discussion 913. DOI: 10.1016/s1091-255x(02)00122-1. View

Paugam-Burtz C, Janny S, Delefosse D, Dahmani S, Dondero F, Mantz J . Prospective validation of the "fifty-fifty" criteria as an early and accurate predictor of death after liver resection in intensive care unit patients. Ann Surg. 2008; 249(1):124-8. DOI: 10.1097/SLA.0b013e31819279cd. View

Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O . Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000; 191(1):38-46. DOI: 10.1016/s1072-7515(00)00261-1. View

Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K . Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997; 26(5):1176-81. DOI: 10.1053/jhep.1997.v26.pm0009362359. View

Nagino M, Nimura Y, Kamiya J, Kondo S, Uesaka K, Kin Y . Changes in hepatic lobe volume in biliary tract cancer patients after right portal vein embolization. Hepatology. 1995; 21(2):434-9. View

Lee K, Kinoshita H, Hirohashi K, Kubo S, Iwasa R . Extension of surgical indications for hepatocellular carcinoma by portal vein embolization. World J Surg. 1993; 17(1):109-15. DOI: 10.1007/BF01655721. View

Jaeck D, Bachellier P, Guiguet M, Boudjema K, Vaillant J, Balladur P . Long-term survival following resection of colorectal hepatic metastases. Association Française de Chirurgie. Br J Surg. 1997; 84(7):977-80. DOI: 10.1002/bjs.1800840719. View

Abdalla E, Barnett C, Doherty D, Curley S, Vauthey J . Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg. 2002; 137(6):675-80; discussion 680-1. DOI: 10.1001/archsurg.137.6.675. View

Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber J, Bachellier P . A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg. 2004; 240(6):1037-49. PMC: 1356519. DOI: 10.1097/01.sla.0000145965.86383.89. View

10.

Abdalla E, Hicks M, Vauthey J . Portal vein embolization: rationale, technique and future prospects. Br J Surg. 2001; 88(2):165-75. DOI: 10.1046/j.1365-2168.2001.01658.x. View

11.

Azoulay D, Castaing D, Smail A, Adam R, Cailliez V, Laurent A . Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg. 2000; 231(4):480-6. PMC: 1421022. DOI: 10.1097/00000658-200004000-00005. View

12.

Pawlik T, Izzo F, Cohen D, Morris J, Curley S . Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann Surg Oncol. 2003; 10(9):1059-69. PMC: 7101740. DOI: 10.1245/aso.2003.03.026. View

13.

Di Stefano D, De Baere T, Denys A, Hakime A, Gorin G, Gillet M . Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients. Radiology. 2004; 234(2):625-30. DOI: 10.1148/radiol.2342031996. View

14.

Wakabayashi H, Ishimura K, Okano K, Karasawa Y, Goda F, Maeba T . Application of preoperative portal vein embolization before major hepatic resection in patients with normal or abnormal liver parenchyma. Surgery. 2002; 131(1):26-33. DOI: 10.1067/msy.2002.118259. View

15.

Vauthey J, Chaoui A, Do K, Bilimoria M, Fenstermacher M, Charnsangavej C . Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery. 2000; 127(5):512-9. DOI: 10.1067/msy.2000.105294. View

16.

Gulec S, Pennington K, Hall M, Fong Y . Preoperative Y-90 microsphere selective internal radiation treatment for tumor downsizing and future liver remnant recruitment: a novel approach to improving the safety of major hepatic resections. World J Surg Oncol. 2009; 7:6. PMC: 2655298. DOI: 10.1186/1477-7819-7-6. View

17.

Giraudo G, Greget M, Oussoultzoglou E, Rosso E, Bachellier P, Jaeck D . Preoperative contralateral portal vein embolization before major hepatic resection is a safe and efficient procedure: a large single institution experience. Surgery. 2008; 143(4):476-82. DOI: 10.1016/j.surg.2007.12.006. View

18.

Capussotti L, Muratore A, Ferrero A, Anselmetti G, Corgnier A, Regge D . Extension of right portal vein embolization to segment IV portal branches. Arch Surg. 2005; 140(11):1100-3. DOI: 10.1001/archsurg.140.11.1100. View

19.

Makuuchi M, Thai B, Takayasu K, Takayama T, Kosuge T, Gunven P . Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990; 107(5):521-7. View

20.

Madoff D, Hicks M, Vauthey J, Charnsangavej C, Morello Jr F, Ahrar K . Transhepatic portal vein embolization: anatomy, indications, and technical considerations. Radiographics. 2002; 22(5):1063-76. DOI: 10.1148/radiographics.22.5.g02se161063. View