Efficacy of Preoperative Portal Vein Embolization Among Patients with Hepatocellular Carcinoma, Biliary Tract Cancer, and Colorectal Liver Metastases: A Comparative Study Based on Single-Center Experience of 319 Cases

  • Suguru Yamashita
  • Yoshihiro Sakamoto
  • Satoshi Yamamoto
  • Nobuyuki Takemura
  • Kiyohiko Omichi
  • Hiroji Shinkawa
  • Kazuhiro Mori
  • Junichi Kaneko
  • Nobuhisa Akamatsu
  • Junichi Arita
  • Kiyoshi Hasegawa
  • Norihiro Kokudo
Hepatobiliary Tumors

DOI: 10.1245/s10434-017-5800-z

Cite this article as:
Yamashita, S., Sakamoto, Y., Yamamoto, S. et al. Ann Surg Oncol (2017). doi:10.1245/s10434-017-5800-z
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Abstract

Background

Efficacy of preoperative portal vein embolization (PVE) has been established; however, differences of outcomes among diseases, including hepatocellular carcinoma (HCC), biliary tract cancer (BTC), and colorectal liver metastases (CLM), are unclear.

Methods

Subjects included patients in a prospectively collected database undergoing PVE (from 1995 to 2013). A future liver remnant (FLR) volume ≥40% is the minimal requirement for patients with an indocyanine green retention rate at 15 min (ICGR15) <10%, and stricter criteria (FLR volume ≥50%) have been applied for patients with 20% > ICGR15 ≥ 10%. Patient characteristics and survivals were compared among those three diseases, and predictors of dropout and better FLR hypertrophy were determined.

Results

In 319 consecutive patients undergoing PVE for HCC (n = 70), BTC (n = 172), and CLM (n = 77), the degree of hypertrophy did not significantly differ by cancer types (median 10, 9.6, and 10%, respectively). Eighty percent (256 of 319) of patients completed subsequent hepatectomy after a median waiting interval of 24 days (range 5–90), while dropout after PVE was more common in BTC or CLM (odds ratio 2.75, p = 0.018), mainly because of disease progression. Ninety-day liver-related mortality after hepatectomy was 0% in the entire cohort, and 5-year overall survival of patients with HCC, BTC, and CLM was 56, 50, and 51%, respectively (p = 0.948). No patients who dropped out survived more than 2.5 years after PVE.

Conclusion

PVE produced equivalent FLR hypertrophy among the three diseases as long as liver function was fulfilling the preset criteria; however, the completion rate of subsequent hepatectomy was highest in HCC. PVE followed by hepatectomy was a safe and feasible strategy for otherwise unresectable disease irrespective of cancer types.

Supplementary material

10434_2017_5800_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)
10434_2017_5800_MOESM2_ESM.tif (3.2 mb)
Supplementary Figure 1. Proposed strategy of portal vein embolization followed by major hepatectomy. A. In patients with hepatocellular carcinoma, selective transcatheter arterial chemoembolization was conducted first to enhance future liver remnant hypertrophy and suppress tumor growth if macroscopic vascular invasion was present. B. In patients with biliary tract cancer, biliary drainage was conducted first if the patient’s condition was compromised by obstructive jaundice. Portal vein embolization was postponed until serum total bilirubin level declined to ≤5.0 mg/dL. C. Upfront surgical resection for initially resectable patients with colorectal liver metastases (CLM) is routinely applied. Patients with technically unresectable CLM at the initial presentation were administered preoperative chemotherapy to convert to technical resectability. (TIFF 3285 kb)
10434_2017_5800_MOESM3_ESM.tif (123 kb)
Supplementary Figure 2. Comparison of total liver volume and indocyanine green retention rate at 15 min before and after portal vein embolization. A. Total liver volume did not significantly differ between pre- and post-portal vein embolization on analysis of the entire cohort or according to disease diagnosis. Median values (horizontal line within each box), interquartile ranges (boxes), and ranges (error bars) are shown. B. Indocyanine green retention rate at 15 min did not significantly differ between pre- and post-portal vein embolization on analysis of the entire cohort or according to disease diagnosis. Median values (horizontal line within each box), interquartile ranges (boxes), and ranges (error bars) are shown. (TIFF 123 kb)

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Suguru Yamashita
    • 1
  • Yoshihiro Sakamoto
    • 1
  • Satoshi Yamamoto
    • 1
  • Nobuyuki Takemura
    • 1
  • Kiyohiko Omichi
    • 1
  • Hiroji Shinkawa
    • 1
  • Kazuhiro Mori
    • 1
  • Junichi Kaneko
    • 1
  • Nobuhisa Akamatsu
    • 1
  • Junichi Arita
    • 1
  • Kiyoshi Hasegawa
    • 1
  • Norihiro Kokudo
    • 1
  1. 1.Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoBunkyo-kuJapan