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Is Portal Vein Embolization Followed by Hepatectomy for Hepatocellular Carcinoma Justified in Patients with Impaired Liver Function?

  • Hepatobiliary Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Portal vein embolization (PVE) was developed for patients with insufficient future liver remnant volume and function and has gained relevant support worldwide before major hepatectomy. However, the efficacy of preoperative PVE for hepatocellular carcinoma (HCC) patients with impaired liver function remains uncertain.

Patients and Methods

Ninety-seven HCC patients who were scheduled for PVE followed by hepatectomy were enrolled in this study. Their short- and long-term outcomes were investigated, according to the liver damage classification defined by the Liver Cancer Study Group of Japan.

Results

Of 97 patients who underwent preoperative PVE, 30 (32.4%) could not undergo subsequent hepatectomy. Dropout rate from treatment strategy was significantly higher in patients with liver damage B (n = 13, 61.5%) than in those with liver damage A (n = 84, 26.2%) (P = 0.014). Among the 67 patients who underwent planned hepatectomy after PVE, 53 were categorized to liver damage A, and 14 were categorized to liver damage B at the point of hepatectomy. Although major complication and mortality rates were comparable between the two groups, the cumulative overall survival (OS) and disease-free survival (DFS) after hepatectomy were markedly worse in patients with liver damage B than in those with liver damage A (5-year OS rate: 23.1% vs 74.6%, P = 0.014, 5-year DFS rate: 7.8% vs 33.5%, P = 0.054, respectively).

Conclusions

The treatment strategy of PVE followed by hepatectomy might be a contraindication for HCC patients with impaired liver function categorized as liver damage B because of the higher dropout rate and poorer long-term outcomes after hepatectomy.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan

    Katsunori Imai MD, PhD, FACS, Yo-ichi Yamashita MD, PhD, FACS, Yosuke Nakao MD, Takashi Matsumoto MD, Shotaro Kinoshita MD, Toshihiko Yusa MD, Yuki Kitano MD, PhD, Takayoshi Kaida MD, PhD, Hiromitsu Hayashi MD, PhD, FACS & Hideo Baba MD, PhD, FACS

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  1. Katsunori Imai MD, PhD, FACS
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  2. Yo-ichi Yamashita MD, PhD, FACS
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  3. Yosuke Nakao MD
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Correspondence to Katsunori Imai MD, PhD, FACS.

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Hideo Baba—Eli Lilly Japan K.K., Taiho Pharmaceutical Co, Ltd., Ono Pharmaceutical Co., Ltd., MSD K.K., Merck Biopharma Co., Ltd.

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Imai, K., Yamashita, Yi., Nakao, Y. et al. Is Portal Vein Embolization Followed by Hepatectomy for Hepatocellular Carcinoma Justified in Patients with Impaired Liver Function?. Ann Surg Oncol 28, 854–862 (2021). https://doi.org/10.1245/s10434-020-08960-2

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