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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

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

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.

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References

  1. Utsunomiya T, Shimada M, Kudo M, et al. Nationwide study of 4741 patients with non-B non-C hepatocellular carcinoma with special reference to the therapeutic impact. Ann Surg. 2014;259:336–45.

    Article  PubMed  Google Scholar 

  2. Kopetz S, Chang GJ, Overman MJ, et al. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol. 2009;27:3677–83.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kishi Y, Abdalla EK, Chun YS, et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg. 2009;250:540–8.

    PubMed  Google Scholar 

  4. Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26:1176–81.

    CAS  PubMed  Google Scholar 

  5. Ebata T, Yokoyama Y, Igami T, et al. Portal vein embolization before extended hepatectomy for biliary cancer: current technique and review of 494 consecutive embolizations. Dig Surg. 2012;29:23–9.

    Article  PubMed  Google Scholar 

  6. 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;107:521–7.

    CAS  PubMed  Google Scholar 

  7. Kokudo N, Tada K, Seki M, et al. Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology. 2001;34:267–72.

    Article  CAS  PubMed  Google Scholar 

  8. Schadde E, Raptis DA, Schnitzbauer AA, et al. Prediction of mortality after ALPPS stage-1: an analysis of 320 patients from the International ALPPS Registry. Ann Surg. 2015;262:780–6.

    Article  PubMed  Google Scholar 

  9. Schadde E, Ardiles V, Robles-Campos R, et al. Early survival and safety of ALPPS: first report of the International ALPPS Registry. Ann Surg. 2014;260:829–38.

    Article  PubMed  Google Scholar 

  10. Li J, Girotti P, Königsrainer I, et al. ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? J Gastrointest Surg. 2013;17:956–61.

    Article  PubMed  Google Scholar 

  11. D’Haese JG, Neumann J, Weniger M, et al. Should ALPPS be used for liver resection in intermediate-stage HCC? Ann Surg Oncol. 2016;23:1335-1343.

    Article  PubMed  Google Scholar 

  12. Madoff DC, Abdalla EK, Gupta S, et al. Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol. 2005;16:215–25.

    Article  PubMed  Google Scholar 

  13. Nagino M, Kamiya J, Kanai M, et al. Right trisegment portal vein embolization for biliary tract carcinoma: technique and clinical utility. Surgery. 2000;127:155–60.

    Article  CAS  PubMed  Google Scholar 

  14. Yoo H, Kim JH, Ko GY, et al. Sequential transcatheter arterial chemoembolization and portal vein embolization versus portal vein embolization only before major hepatectomy for patients with hepatocellular carcinoma. Ann Surg Oncol. 2011;18:1251–7.

    Article  PubMed  Google Scholar 

  15. Yokoyama Y, Ebata T, Igami T, et al. The adverse effects of preoperative cholangitis on the outcome of portal vein embolization and subsequent major hepatectomies. Surgery. 2014;156:1190–6.

    Article  PubMed  Google Scholar 

  16. 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  PubMed  Google Scholar 

  17. Yamashita S, Hasegawa K, Takahashi M, et al. One-stage hepatectomy following portal vein embolization for colorectal liver metastasis. World J Surg. 2013;37:622–8.

    Article  PubMed  Google Scholar 

  18. Aoki T, Imamura H, Hasegawa K, et al. Sequential preoperative arterial and portal venous embolizations in patients with hepatocellular carcinoma. Arch Surg. 2004;139:766–4.

    Article  PubMed  Google Scholar 

  19. Seyama Y, Kubota K, Sano K, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003;238:73–83.

    PubMed  PubMed Central  Google Scholar 

  20. Oba M, Hasegawa K, Shindoh J, et al. Survival benefit of repeat resection of successive recurrences after the initial hepatic resection for colorectal liver metastases. Surgery. 2016;159:632–40.

    Article  PubMed  Google Scholar 

  21. Imamura H, Shimada R, Kubota M, et al. Preoperative portal vein embolization: an audit of 84 patients. Hepatology. 1999;29:1099–105.

    Article  CAS  PubMed  Google Scholar 

  22. Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.

    Article  PubMed  Google Scholar 

  23. Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22:696–9.

    Article  CAS  PubMed  Google Scholar 

  24. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS) Surgery. 2011;149:713–24.

    Article  PubMed  Google Scholar 

  26. Miyakawa S, Ishihara S, Horiguchi A, et al. Biliary tract cancer treatment: 5,584 results from the Biliary Tract Cancer Statistics Registry from 1998 to 2004 in Japan. J Hepatobiliary Pancreat Surg. 2009;16:1–7.

    Article  PubMed  Google Scholar 

  27. Mavros MN, Economopoulos KP, Alexiou VG, et al. Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis. JAMA Surg. 2014;149:565–574.

    Article  PubMed  Google Scholar 

  28. Torzilli G, Belghiti J, Kokudo N, et al. A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations? An observational study of the HCC East-West study group. Ann Surg. 2013;257:929–37.

    Article  PubMed  Google Scholar 

  29. Oba M, Hasegawa K, Matsuyama Y, et al. Discrepancy between recurrence-free survival and overall survival in patients with resectable colorectal liver metastases: a potential surrogate endpoint for time to surgical failure. Ann Surg Oncol. 2014;21:1817–24.

    Article  PubMed  Google Scholar 

  30. 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; 217:126–34.

    Article  PubMed  Google Scholar 

  31. Mise Y, Passot G, Wang X, et al. A nomogram to predict hypertrophy of liver segments 2 and 3 after right portal vein embolization. J Gastrointest Surg. 2016;20:1317–23.

    Article  PubMed  Google Scholar 

  32. Iakova P, Awad SS, Timchenko NA. Aging reduces proliferative capacities of liver by switching pathways of C/EBPalpha growth arrest. Cell. 2003;113:495–506.

    Article  CAS  PubMed  Google Scholar 

  33. Oldhafer KJ, Stavrou GA, van Gulik TM, et al. ALPPS-where do we stand, where do we go? Eight Recommendations from the First International Expert Meeting. Ann Surg. 2016;263:839–41.

    Article  PubMed  Google Scholar 

  34. Igami T, Ebata T, Yokoyama Y, et al. Portal vein embolization using absolute ethanol: evaluation of its safety and efficacy. J Hepatobiliary Pancreat Sci. 2014;21:676–81.

    Article  PubMed  Google Scholar 

  35. Farges O, Belghiti J, Kianmanesh R, et al. Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg. 2003;237:208–17.

    PubMed  PubMed Central  Google Scholar 

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Funding

No grant support or other funding was received in respect of this study.

Disclosure

Suguru Yamashita, Yoshihiro Sakamoto, Satoshi Yamamoto, Nobuyuki Takemura, Kiyohiko Omichi, Hiroji Shinkawa, Kazuhiro Mori, Junichi Kaneko, Nobuhisa Akamatsu, Junichi Arita, Kiyoshi Hasegawa, and Norihiro Kokudo have no conflicts of interest associated with this study.

Author information

Authors and Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan

    Suguru Yamashita MD, PhD, Yoshihiro Sakamoto MD, PhD, Satoshi Yamamoto MD, PhD, Nobuyuki Takemura MD, PhD, Kiyohiko Omichi MD, PhD, Hiroji Shinkawa MD, PhD, Kazuhiro Mori MD, Junichi Kaneko MD, PhD, Nobuhisa Akamatsu MD, PhD, Junichi Arita MD, PhD, Kiyoshi Hasegawa MD, PhD & Norihiro Kokudo MD, PhD

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  1. Suguru Yamashita MD, PhD
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  2. Yoshihiro Sakamoto MD, PhD
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  3. Satoshi Yamamoto MD, PhD
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  4. Nobuyuki Takemura MD, PhD
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  5. Kiyohiko Omichi MD, PhD
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  6. Hiroji Shinkawa MD, PhD
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  7. Kazuhiro Mori MD
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  8. Junichi Kaneko MD, PhD
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  9. Nobuhisa Akamatsu MD, PhD
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  10. Junichi Arita MD, PhD
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  11. Kiyoshi Hasegawa MD, PhD
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  12. Norihiro Kokudo MD, PhD
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Corresponding author

Correspondence to Norihiro Kokudo MD, PhD.

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Supplementary material 1 (DOCX 17 kb)

10434_2017_5800_MOESM2_ESM.tif

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

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)

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Yamashita, S., Sakamoto, Y., Yamamoto, S. et al. 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 (2017). https://doi.org/10.1245/s10434-017-5800-z

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  • DOI: https://doi.org/10.1245/s10434-017-5800-z

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