Abstract
Background
Portal vein embolisation (PVE) can be used to increase the remnant liver parenchyma volume before major hepatectomy but may stimulate tumour growth. The pattern of disease recurrence and long-term survival has not been adequately addressed.
Methods
Over a period of 7 years 36 patients underwent preoperative PVE before resection of four or more liver segments for colorectal cancer (CRC) liver metastases. PVE was performed when the future liver remnant (FLR) assessed by magnetic resonance imaging (MRI) scan volumetry was less than 30%. Disease-free and overall survival was compared with a control group (65 patients) undergoing extended right/right hepatectomy for CRC metastases without PVE during the same time period.
Results
PVE was successful in all patients. PVE increased the median FLR volume by 37% [295 ml (22%) to 404 ml (32%), p < 0.0001]. 61% of patients undergoing PVE proceeded to liver resection (n = 22). Twelve patients (33%) developed disease progression following PVE. The 5-year survival after liver resection with PVE was 25%, compared with 50% without PVE. The 5-year disease-free survival was 30% post PVE and 50% without PVE.
Conclusion
We conclude that PVE significantly increases the future liver remnant. Only two-thirds of patients proceed to resection because of disease progression. Long-term survival is less than in patients who do not require PVE. The effect of PVE on tumour growth requires investigation.
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References
Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer. Br J Cancer. 2006;94(7):982–99.
Schindl MJ, Redhead DN, Fearon KC, Garden OJ, Wigmore SJ. Edinburgh Liver Surgery and Transplantation Experimental Research Group (eLISTER). The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut. 2005;54(2):289–96.
Melendez J, Ferri E, Zwillman M, et al. Extended hepatic resection: a 6-year retrospectivestudy of risk factors for perioperative mortality. J Am Coll Surg. 2001;192:47–53.
Kinoshita H, Sakai K, Hirohashi K, et al. Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg. 1986;10:803–8.
Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolizationto increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107:521–7.
Azoulay D, Castaing D, Smail A, et al. Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg. 2000;231:480–6.
Elias D, De Baere T, Roche A, et al. During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma. Br J Surg. 1999;86:784–8.
Jaeck D, Bachellier P, Nakano H, Oussoultzoglou E, Weber JC, Wolf P, et al. One or two stage hepatectomy combined with portal vein embolisation for initially nonresectable colorectal liver metastases. Am J Surg. 2003;185(3):221–9.
Lindner P, Cahlin C, Friman S, Hafstrome L, Klingenstierna H, Lonn L, et al. Extended right sided liver resection for colorectal liver metastases-impact of percutaneous portal venous embolisation. Eur J Surg Oncol. 2006;32(3):292–6.
Beal I, Anthony S, Papadopoulou A, Huthins R, Fusai K, Begent R, et al. The effect of chemotherapy in patients undergoing portal vein embolisation prior to hepatic resection for colorectal liver metastases. Br J Radiol. 2006;79(942):473–8.
Bhattacharjya S, Aggarwal R, Davidson BR. Intense follow up after liver resection for colorectal metastases—results of combined serial tumor markers estimations and computed tomography of the chest and abdomen—a prospective study. Br J Cancer. 2006;95:21–6.
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;94:1386–94.
Giraudo G, Greget M, Oussoultzoglou E, Rosso E, Bachellier P, Jaeck D. Preoperative contralateral portal vein embolization before major hepatic resection is a safe and efficient procedure: a large single institution experience. Surgery. 2008;143(4):476–82.
Ferrero A, Viganò L, Polastri R, Muratore A, Eminefendic H, Regge D, et al. Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg. 2007;31(8):1643–51.
Zorzi D, Laurent A, Pawlik TM, Lauwers GY, Vauthey JN, Abdalla EK. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg. 2007;94(3):274–86.
Hewes JC, Dighe S, Morris RW, Hutchins RR, Bhattacharya S, Davidson BR. Preoperative chemotherapy and the outcome of liver resection for colorectal metastases. World J Surg. 2007;31(2):353–64.
Dinant S, de Graaf W, Verwer BJ, Bennink RJ, van Lienden KP, Gouma DJ, et al. Risk assessment of posthepatectomy liver failure using hepatobiliary scintigraphy and CT volumetry. J Nucl Med. 2007;48(5):685–92.
Mueller L, Hillert C, Möller L, Krupski-Berdien G, Rogiers X, Broering DC. Major hepatectomy for colorectal metastases: is preoperative portal occlusion an oncological risk factor? Ann Surg Oncol. 2008;15(7):1908–17.
Kokudo N, Tada K, Seki M, et al. Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology. 2001;34:267–272.
Pamecha V, Levene A, Federica G, Dhillon A, Davidson BR. Effect of portal vein embolisation on tumor morphology of colorectal cancer liver metastases. HPB (Oxford). 2008;10(S1):227–8.
Adam R, Pascal G, Castaing D, Azoulay D, Delvart V, Paule B, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240(6):1052–61; discussion 1061–4.
Wang X, Hershman DL, Abrams JA, Feingold D, Grann VR, Jacobson JS, et al. Predictors of survival after hepatic resection among patients with colorectal liver metastasis. Br J Cancer. 2007;97(12):1606–12.
Abdalla EK, Vauthey JN. Improved survival after resection of colorectal liver metastases. J Clin Oncol. 2006;24(17):2679.
Covey AM, Brown KT, Jarnagin WR, Brody LA, Schwartz L, Tuorto S, et al. Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases. Ann Surg. 2008;247(3):451–5.
Goéré D, Farges O, Leporrier J, Sauvanet A, Vilgrain V, Belghiti J. Chemotherapy does not impair hypertrophy of the left liver after right portal vein obstruction. J Gastrointest Surg. 2006;10(3):365–70.
Zuckerman DS, Clark JW. Systemic therapy for metastatic colorectal cancer: current questions. Cancer. 2008;112(9):1879–91.
Oussoultzoglou E, Bachellier P, Rosso E, Scurtu R, Lucescu I, Greget M, et al. Right portal vein embolization before right hepatectomy for unilobar colorectal liver metastases reduces the intrahepatic recurrence rate. Ann Surg. 2006;244(1):71–79.
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Pamecha, V., Glantzounis, G., Davies, N. et al. Long-Term Survival and Disease Recurrence Following Portal Vein Embolisation Prior to Major Hepatectomy for Colorectal Metastases. Ann Surg Oncol 16, 1202–1207 (2009). https://doi.org/10.1245/s10434-008-0269-4
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DOI: https://doi.org/10.1245/s10434-008-0269-4