Skip to main content
SpringerLink
Log in

Hepatic vein embolization after portal vein embolization to induce additional liver hypertrophy in patients with metastatic colorectal carcinoma

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the effect of salvage hepatic vein embolization (HVE) on the volume of the future liver remnant (FLR) for patients with metastatic colorectal cancer (mCRC) and inadequate hypertrophy following initial portal vein embolization (PVE).

Methods

From April 2011 to October 2018, 9 patients with mCRC underwent HVE following PVE. The right or middle hepatic vein was embolized with coils and/or vascular plugs. Liver volumes were calculated at baseline, following PVE, and following HVE, in order to assess the hypertrophic effect of PVE and HVE on the FLR.

Results

Nine patients underwent HVE (n = 3, right HVE; n = 6, middle HVE) because of inadequate FLR hypertrophy following PVE. The standardized FLR increased from 0.16 (median, range 0.08–0.24) at baseline to 0.22 (median, range 0.13–0.29) following PVE (p = 0.0005) to 0.26 (median, range 0.19–0.37) following HVE (p = 0.0050). HVE was performed 40 days (median, range 19–128 days) following PVE, and assessment of FLR hypertrophy was performed 41 days (median, range 19–92 days) following HVE. Four of nine patients underwent hepatectomy; 5 patients failed to undergo hepatectomy (n = 3, inadequate hypertrophy; n = 1, disease progression; n = 1, portal hypertension). One patient required repeat HVE due to a patent accessory vein.

Conclusions

Salvage HVE is an effective technique to induce additional FLR hypertrophy in patients with mCRC and inadequate FLR after initial PVE.

Key Points

• Hepatic vein embolization is effective to induce additional liver hypertrophy in surgical patients with metastatic colorectal carcinoma and inadequate hypertrophy after portal vein embolization.

• Increases in future liver remnant volume are feasible in patients who receive hepatotoxic neoadjuvant systemic therapy for metastatic colorectal carcinoma.

• Sequential portal vein embolization and hepatic vein embolization can be a viable technique to induce liver hypertrophy in patients with small baseline future liver remnant volumes (< 20%).

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

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

BSA:

Body surface area

eLVD:

Extended liver venous deprivation

FLR:

Future liver remnant

FOLFIRI:

Irinotecan plus leucovorin calcium and fluorouracil

FOLFOX:

Leucovorin calcium, fluorouracil, and oxaliplatin

HVE:

Hepatic vein embolization

mCRC:

Metastatic colorectal carcinoma

MHVE:

Middle hepatic vein embolization

PVE:

Portal vein embolization

RHVE:

Right hepatic vein embolization

RPVE+4:

Right PVE extended to segment 4 portal veins

sFLR:

Standardized future liver remnant

sTLV:

Standardized total liver volume

References

  1. Abdalla EK, Hicks ME, Vauthey JN (2001) Portal vein embolization: rationale, technique and future prospects. Br J Surg 88:165–175

    Article  CAS  Google Scholar 

  2. Bellentani S, Hardison WG, Manenti F (1985) Mechanisms of liver adaptation to prolonged selective biliary obstruction (SBO) in the rat. J Hepatol 1:525–535

    Article  CAS  Google Scholar 

  3. Goere D, Farges O, Leporrier J, Sauvanet A, Vilgrain V, Belghiti J (2006) Chemotherapy does not impair hypertrophy of the left liver after right portal vein obstruction. J Gastrointest Surg 10:365–370

    Article  Google Scholar 

  4. Covey AM, Brown KT, Jarnagin WR et al (2008) Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases. Ann Surg 247:451–455

    Article  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  6. Abulkhir A, Limongelli P, Healey AJ et al (2008) Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg 247:49–57

    Article  Google Scholar 

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

    Article  Google Scholar 

  8. Yamashita S, Sakamoto Y, Yamamoto S et al (2017) 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. Ann Surg Oncol 24:1557–1568

    Article  Google Scholar 

  9. Hwang S, Ha TY, Ko GY et al (2015) Preoperative sequential portal and hepatic vein embolization in patients with hepatobiliary malignancy. World J Surg 39:2990–2998

    Article  Google Scholar 

  10. Hwang S, Lee SG, Ko GY et al (2009) Sequential preoperative ipsilateral hepatic vein embolization after portal vein embolization to induce further liver regeneration in patients with hepatobiliary malignancy. Ann Surg 249:608–616

    Article  Google Scholar 

  11. Guiu B, Quenet F, Escal L et al (2017) Extended liver venous deprivation before major hepatectomy induces marked and very rapid increase in future liver remnant function. Eur Radiol 27:3343–3352

    Article  Google Scholar 

  12. Shindoh J, Vauthey JN, Zimmitti G et al (2013) 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 217:126–133 discussion 124–133

    Article  Google Scholar 

  13. Kooby DA, Fong Y, Suriawinata A et al (2003) Impact of steatosis on perioperative outcome following hepatic resection. J Gastrointest Surg 7:1034–1044

    Article  Google Scholar 

  14. Rubbia-Brandt L, Audard V, Sartoretti P et al (2004) Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 15:460–466

    Article  CAS  Google Scholar 

  15. Vauthey JN, Pawlik TM, Ribero D et al (2006) Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 24:2065–2072

    Article  CAS  Google Scholar 

  16. Tisman G, MacDonald D, Shindell N et al (2004) Oxaliplatin toxicity masquerading as recurrent colon cancer. J Clin Oncol 22:3202–3204

    Article  Google Scholar 

  17. Azoulay D, Castaing D, Krissat J et al (2000) Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver. Ann Surg 232:665–672

    Article  CAS  Google Scholar 

  18. Adam R, Delvart V, Pascal G et al (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240:644–657 discussion 648–657

    Article  Google Scholar 

  19. Kishi Y, Zorzi D, Contreras CM et al (2010) Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases. Ann Surg Oncol 17:2870–2876

    Article  Google Scholar 

  20. Vauthey JN, Pawlik TM, Abdalla EK et al (2004) Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg 239:722–730 discussion 722–730

    Article  Google Scholar 

  21. Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN (2002) Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 137:675–680 discussion 671–680

    Article  Google Scholar 

  22. Vauthey JN, Abdalla EK, Doherty DA et al (2002) Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 8:233–240

    Article  Google Scholar 

  23. Madoff DC, Hicks ME, Abdalla EK, Morris JS, Vauthey JN (2003) Portal vein embolization with polyvinyl alcohol particles and coils in preparation for major liver resection for hepatobiliary malignancy: safety and effectiveness—study in 26 patients. Radiology 227:251–260

    Article  Google Scholar 

  24. Madoff DC, Abdalla EK, Gupta S et al (2005) Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol 16:215–225

    Article  Google Scholar 

  25. Ku Y, Fukumoto T (2011) Hepaic vein embolization. In: Madoff DC, Makuuchi M, Nagino M, Vauthey J-N (eds) Venous embolization of the liver: radiologic and surgical practice. Springer, London, pp 169–175

  26. Colbert LE, Cloyd JM, Koay EJ, Crane CH, Vauthey JN (2017) Proton beam radiation as salvage therapy for bilateral colorectal liver metastases not amenable to second-stage hepatectomy. Surgery 161:1543–1548

    Article  Google Scholar 

  27. Brouquet A, Abdalla EK, Kopetz S et al (2011) High survival rate after two-stage resection of advanced colorectal liver metastases: response-based selection and complete resection define outcome. J Clin Oncol 29:1083–1090

    Article  Google Scholar 

  28. Adam R, Laurent A, Azoulay D, Castaing D, Bismuth H (2000) Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors. Ann Surg 232:777–785

    Article  CAS  Google Scholar 

  29. Mullen JT, Ribero D, Reddy SK et al (2007) Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 204:854–862 discussion 854–862

    Article  Google Scholar 

  30. Widmann WD, Hales MR, Greenspan RH (1962) The effects of hepatic vein occlusions. Am J Pathol 41:439–454

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Maetani S (1965) Experimental obstruction of left hepatic vein in dogs. I. Histopathological changes and gross vascular alterations. Nihon Geka Hokan 34:216–233

    CAS  PubMed  Google Scholar 

  32. Tani K, Shindoh J, Akamatsu N et al (2016) Venous drainage map of the liver for complex hepatobiliary surgery and liver transplantation. HPB (Oxford) 18:1031–1038

    Article  Google Scholar 

  33. Theilig D, Steffen I, Malinowski M et al (2019) Predicting liver failure after extended right hepatectomy following right portal vein embolization with gadoxetic acid-enhanced MRI. Eur Radiol 29:5861–5872

    Article  Google Scholar 

  34. Asenbaum U, Kaczirek K, Ba-Ssalamah A et al (2018) Post-hepatectomy liver failure after major hepatic surgery: not only size matters. Eur Radiol 28:4748–4756

    Article  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Andrew S. Niekamp, Steven Y. Huang, Armeen Mahvash, Bruno C. Odisio & Kamran Ahrar

  2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Ching-Wei D. Tzeng & Jean-Nicolas Vauthey

Authors
  1. Andrew S. Niekamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven Y. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Armeen Mahvash
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bruno C. Odisio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kamran Ahrar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ching-Wei D. Tzeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-Nicolas Vauthey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven Y. Huang.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Steven Y. Huang.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

Additional information

Publisher’s note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Niekamp, A.S., Huang, S.Y., Mahvash, A. et al. Hepatic vein embolization after portal vein embolization to induce additional liver hypertrophy in patients with metastatic colorectal carcinoma. Eur Radiol 30, 3862–3868 (2020). https://doi.org/10.1007/s00330-020-06746-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-020-06746-4

Keywords

Search

Navigation