scholarly journals Portal vein embolization before liver resection for perihilar cholangiocarcinoma reduces the risk of liver failure and perioperative mortality

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S387
Author(s):  
P. Olthof ◽  
B. Groot Koerkamp ◽  
W. Jarnagin ◽  
L. Aldrighetti ◽  
P. Muiesan ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Liver Failure ◽  
Portal Vein Embolization ◽  
Perihilar Cholangiocarcinoma ◽  
Perioperative Mortality

scholarly journals Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

2020 ◽  
Vol 27 (7) ◽  
pp. 2311-2318 ◽  
Author(s):  
Pim B. Olthof ◽  
◽  
Luca Aldrighetti ◽  
Ruslan Alikhanov ◽  
Matteo Cescon ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Liver Failure ◽  
Portal Vein Embolization ◽  
Future Liver Remnant ◽  
International Study ◽  
Perihilar Cholangiocarcinoma ◽  
Major Liver Resection ◽  
Biliary Leakage ◽  
Liver Remnant

Abstract Background Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p < 0.001 and p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p < 0.001), as was biliary leakage (10% vs. 35%, p < 0.01), intra-abdominal abscesses (19% vs. 34%, p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.

scholarly journals The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol

2020 ◽  
Author(s):  
Mihai-Calin Pavel ◽  
Raquel Casanova ◽  
Laia Estalella ◽  
Robert Memba ◽  
Erik Llàcer-Millán ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Neoadjuvant Chemotherapy ◽  
Portal Vein ◽  
Liver Failure ◽  
Liver Regeneration ◽  
Portal Vein Embolization ◽  
Number Of Cycles

Abstract Introduction: Liver resection (LR) in patients with liver metastasis from colo-rectal cancer remains the only curative treatment. Perioperative chemotherapy improves prognosis of these patients. However, there are concerns regarding the effect of preoperative chemotherapy on liver regeneration, which is a key event in avoiding liver failure after LR. The primary objective of this systematic review is to assess the effect of neoadjuvant chemotherapy on liver regeneration after (LR) or portal vein embolization (PVE) in patients with liver metastasis from colo-rectal cancer. The secondary objectives are to evaluate the impact of the type of chemotherapy, number of cycles and time between end of treatment and procedure (LR or PVE) and to investigate whether there is an association between degree of hypertrophy and postoperative liver failure.Methods: The design of this systematic review will follow the current recommendations of PRISMA. Pubmed, Scopus, Web of Science, Embase and Cochrane databases will be searched We will include studies reporting liver regeneration rates in patients submitted to LR or PVE. Only studies comparing neoadjuvant vs no chemotherapy, or comparing chemotherapy characteristics (bevacizumab administration, number of cycles and time from finishing chemotherapy until intervention) will be included. We will select studies from 1990 to present. Two researchers will individually screen the identified records, according to a list of inclusion and exclusion criteria. Primary outcome will be future liver remnant regeneration rate. Bias of the studies will be evaluated with the ROBINS-I tool and quality of evidence for all outcomes will be determined with the GRADE system. The data will be registered in a predesigned database. If selected studies are sufficiently homogeneous, we will perform a meta-analysis of reported results. In the event of a substantial heterogeneity, a qualitive systematic review will be performed.Discussion: The results of this systematic review may help to better identify the patients affected by liver metastasis that could present low regeneration rates after neoadjuvant chemotherapy. These patients are at risk to develop liver failure after extended hepatectomies and therefore are not good candidates for such aggressive procedures.Systematic Review Registration: PROSPERO registration number: CRD42020178481 (July 5th 2020).

scholarly journals Effect of structured use of preoperative portal vein embolization on outcomes after liver resection of perihilar cholangiocarcinoma

BJS Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. 449-455 ◽  
Author(s):  
L. C. Franken ◽  
F. Rassam ◽  
K. P. van Lienden ◽  
R. J. Bennink ◽  
M. G. Besselink ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Portal Vein Embolization ◽  
Perihilar Cholangiocarcinoma

scholarly journals The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol

2020 ◽  
Author(s):  
Mihai-Calin Pavel ◽  
Raquel Casanova ◽  
Laia Estalella ◽  
Robert Memba ◽  
Erik Llàcer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Neoadjuvant Chemotherapy ◽  
Portal Vein ◽  
Liver Failure ◽  
Liver Regeneration ◽  
Portal Vein Embolization ◽  
Liver Remnant ◽  
The Impact

Abstract Introduction The primary objective of this systematic review is to assess the effect of neoadjuvant chemotherapy on liver regeneration after liver resection (LR) or portal vein embolization (PVE) in patients with liver metastasis from colo-rectal cancer. The secondary objectives are to evaluate the impact of the type of chemotherapy, number of cycles and time between end of treatment and procedure (LR or PVE) and to investigate whether there is an association between degree of hypertrophy and postoperative liver failure. Methods The design of this systematic review will follow the current recommendations of PRISMA. After an exhaustive literature search with pre-established criteria, two researchers will individually screen the identified records, according to a list of inclusion and exclusion criteria. Primary outcome will be future liver remnant regeneration rate. All data will be registered in a predesigned database. In the event of a substantial heterogeneity of selected articles, a narrative systematic review will be performed. Discussion The results of this systematic review may help to better identify the patients affected by liver metastasis that could present low regeneration rates after neoadjuvant chemotherapy. These patients are at risk to develop liver failure after extended hepatectomies and therefore are not good candidates for such aggressive procedures. Systematic Review Registration PROSPERO registration number: CRD42020178481 (July 5th 2020).

scholarly journals The effect of preoperative chemotherapy on liver regeneration after portal vein embolization/ligation or liver resection in patients with colorectal liver metastasis: a systematic review protocol

2020 ◽  
Author(s):  
Mihai-Calin Pavel ◽  
Raquel Casanova ◽  
Laia Estalella ◽  
Robert Memba ◽  
Erik Llàcer-Millán ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Neoadjuvant Chemotherapy ◽  
Portal Vein ◽  
Liver Failure ◽  
Liver Regeneration ◽  
Preoperative Chemotherapy ◽  
Portal Vein Embolization

Abstract Introduction: Liver resection (LR) in patients with liver metastasis from colo-rectal cancer remains the only curative treatment. Perioperative chemotherapy improves prognosis of these patients. However, there are concerns regarding the effect of preoperative chemotherapy on liver regeneration, which is a key event in avoiding liver failure after LR. The primary objective of this systematic review is to assess the effect of neoadjuvant chemotherapy on liver regeneration after (LR) or portal vein embolization (PVE) in patients with liver metastasis from colo-rectal cancer. The secondary objectives are to evaluate the impact of the type of chemotherapy, number of cycles and time between end of treatment and procedure (LR or PVE) and to investigate whether there is an association between degree of hypertrophy and postoperative liver failure.Methods: The design of this systematic review will follow the current recommendations of PRISMA. After an exhaustive literature search with pre-established criteria, two researchers will individually screen the identified records, according to a list of inclusion and exclusion criteria. Primary outcome will be future liver remnant regeneration rate. All data will be registered in a predesigned database. In the event of a substantial heterogeneity of selected articles, a narrative systematic review will be performed.Discussion: The results of this systematic review may help to better identify the patients affected by liver metastasis that could present low regeneration rates after neoadjuvant chemotherapy. These patients are at risk to develop liver failure after extended hepatectomies and therefore are not good candidates for such aggressive procedures.Systematic Review Registration: PROSPERO registration number: CRD42020178481 (July 5th 2020).

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