Skip to main content
SpringerLink
Log in

Preoperative Portal Vein Embolization Is Not Associated with Increased Postoperative Complications After Major Hepatectomy: a Study of the National Surgical Quality Improvement Database

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Preoperative portal vein embolization (PVE) is selectively performed to induce hypertrophy of the future liver remnant prior to major liver resection. The primary aim of this study was to determine the association of PVE with liver-specific and overall postoperative morbidity.

Methods

A retrospective cohort study of patients who underwent major hepatectomy from 2014 to 2016 within the ACS-NSQIP hepatectomy-specific module was performed.

Results

Of the 3912 patients identified, 9.9% (N = 388) underwent PVE. Patients who underwent PVE were older (59.1 vs. 57.7 years). Most patients in the PVE cohort underwent right hepatectomy (51.8%, N = 201) or trisectionectomy (46.1%, N = 179), compared with right (49.3%, N = 1738) and left hepatectomy (29.6%, N = 1042) in the non-PVE cohort (p < 0.001). Median operative time was longer in the PVE group (310 vs. 276 min, p < 0.001). Post-hepatectomy liver failure was more common among patients undergoing PVE (18.6% (N = 72) vs. 9.9% (N = 350), p < 0.001), as was bile leak (17.3% (N = 67) vs. 12.2% (N = 428), p = 0.005). Overall complication rates were higher among patients who underwent PVE (45.9% (N = 178) vs. 34.0% (N = 1199), p < 0.001). However, on multivariable analysis controlling for patient and technical factors, PVE remained associated with an increased risk of liver-specific complications (OR 1.33, 95% CI 1.01–1.74) but not with overall complications (OR 1.17, 95% CI 0.92–1.50).

Conclusion

Within a national cohort, patients treated with PVE are older and undergo a more extensive liver resection. When controlling for patient and technical factors, PVE is neither associated with an increase in overall morbidity nor mortality, suggesting that PVE can be safely used in appropriate patients undergoing major hepatectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Makuuchi M, Takayasu K, Takuma T. Preoperative Transcatheter Embolization of the Portal Venous Branch for Patients Receiving Extended Lobectomy due to the Bile Duct Carcinoma. The Journal of the Japanese Practical Surgeon Society 1984: 45:1558–1564.

    Article  Google Scholar 

  2. Makuuchi M, Thai BL, Takayasu K et. al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990: 107:521–527.

    CAS  PubMed  Google Scholar 

  3. Azoulay D, Castaing D, Smail A et. al. Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 2000: 231:480–486.

    Article  CAS  Google Scholar 

  4. Palavecino M, Chun YS, Madoff DC et. al. Major hepatic resection for hepatocellular carcinoma with or without portal vein embolization: Perioperative outcome and survival. Surgery 2009: 145:399–405.

    Article  Google Scholar 

  5. Farges O, Belghiti J, Kianmanesh R et. al. Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 2003: 237:208–217.

    PubMed  PubMed Central  Google Scholar 

  6. Shindoh J, Tzeng CW, Aloia TA et. al. Optimal future liver remnant in patients treated with extensive preoperative chemotherapy for colorectal liver metastases. Ann Surg Oncol 2013: 20:2493–2500.

    Article  Google Scholar 

  7. Nagino M, Nimura Y, Kamiya J et. al. Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma. Surgery 1995: 117:677–681.

    Article  CAS  Google Scholar 

  8. Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 2002: 137:1.

    Article  Google Scholar 

  9. Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg 2007: 94:1386–1394.

    Article  CAS  Google Scholar 

  10. Massimino KP, Kolbeck KJ, Enestvedt CK, Orloff S, Billingsley KG. Safety and efficacy of preoperative right portal vein embolization in patients at risk for postoperative liver failure following major right hepatectomy. HPB (Oxford) 2012: 14:14–19.

    Article  Google Scholar 

  11. Shindoh J, Vauthey JN, Zimmitti G et. al. Analysis of the efficacy of portal vein embolization for patients with extensive liver malignancy and very low future liver remnant volume, including a comparison with the associating liver partition with portal vein ligation for staged hepatectomy approach. J Am Coll Surg 2013: 217:4.

    Article  Google Scholar 

  12. Shindoh J, Tzeng CW, Aloia TA et. al. Safety and efficacy of portal vein embolization before planned major or extended hepatectomy: an institutional experience of 358 patients. J Gastrointest Surg 2014: 18:45–51.

    Article  Google Scholar 

  13. American College of Surgeons National Surgical Quality Improvement Program ACS NSQIP Participant Use Data File. Available: https://www.facs.org/quality-programs/acs-nsqip/participant-use [accessed June 4, 2019].

  14. Cloyd JM, Mizuno T, Kawaguchi Y et. al. Comprehensive Complication Index Validates Improved Outcomes Over Time Despite Increased Complexity in 3707 Consecutive Hepatectomies. Ann Surg 2018.

  15. Aloia TA, Zimmitti G, Conrad C, Gottumukalla V, Kopetz S, Vauthey JN. Return to intended oncologic treatment (RIOT): a novel metric for evaluating the quality of oncosurgical therapy for malignancy. J Surg Oncol 2014: 110:107–114.

    Article  Google Scholar 

  16. Ironside N, Bell R, Bartlett A, McCall J, Powell J, Pandanaboyana S. Systematic review of perioperative and survival outcomes of liver resections with and without preoperative portal vein embolization for colorectal metastases. HPB (Oxford) 2017: 19:559–566.

    Article  Google Scholar 

  17. Nordlinger B, Sorbye H, Glimelius B et. al. Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial. Lancet 2008: 371:1007–1016.

    Article  CAS  Google Scholar 

  18. Karoui M, Penna C, Amin-Hashem M et. al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006: 243:1–7.

    Article  Google Scholar 

  19. Aloia T, Sebagh M, Plasse M et. al. Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases. J Clin Oncol 2006: 24:4983–4990.

    Article  CAS  Google Scholar 

  20. Giglio MC, Giakoustidis A, Draz A et. al. Oncological Outcomes of Major Liver Resection Following Portal Vein Embolization: A Systematic Review and Meta-analysis. Ann Surg Oncol 2016: 23:3709–3717.

    Article  Google Scholar 

  21. Schnitzbauer AA, Lang SA, Goessmann H et. al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 2012: 255:405–414.

    Article  Google Scholar 

  22. Sandstrom P, Rosok BI, Sparrelid E et. al. ALPPS Improves Resectability Compared With Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastasis: Results From a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial). Ann Surg 2018: 267:833–840.

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Rebecca A. Snyder & Alexander A. Parikh

    Present address: Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Blvd Surgical Oncology Suite 4S-24, Greenville, NC, 27834, USA

Authors and Affiliations

  1. Department of Surgery, University of South Carolina School of Medicine-Greenville, Greenville, SC, USA

    Rebecca A. Snyder, Joseph A. Ewing & Alexander A. Parikh

  2. Department of Public Health, East Carolina University Brody School of Medicine, Greenville, NC, USA

    Rebecca A. Snyder

Authors
  1. Rebecca A. Snyder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph A. Ewing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander A. Parikh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Rebecca A. Snyder: Conception/design of the work; acquisition of the data, data analysis, and interpretation of the data; drafting manuscript; final approval of the manuscript.

Joseph A. Ewing: Acquisition of data and data analysis; critical revision of the manuscript; final approval of the manuscript.

Alexander A. Parikh: Conception/design of the work; data analysis and interpretation of the data; critical revision of the manuscript; final approval of the manuscript.

All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Alexander A. Parikh.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This work has been presented as an oral presentation at the Americas Hepato-Pancreato-Biliary Association annual meeting in Miami, FL, March 24, 2019.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Snyder, R.A., Ewing, J.A. & Parikh, A.A. Preoperative Portal Vein Embolization Is Not Associated with Increased Postoperative Complications After Major Hepatectomy: a Study of the National Surgical Quality Improvement Database. J Gastrointest Surg 24, 1561–1570 (2020). https://doi.org/10.1007/s11605-019-04313-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-019-04313-x

Keywords

Search

Navigation