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

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.

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Future Liver Remnant Indocyanine Green Plasma Clearance Rate as a Predictor of Post-hepatectomy Liver Failure After Portal Vein Embolization

CardioVascular and Interventional Radiology ◽

10.1007/s00270-018-2065-2 ◽

2018 ◽

Vol 41 (12) ◽

pp. 1877-1884 ◽

Cited By ~ 2

Author(s):

Mitsunari Maruyama ◽

Takeshi Yoshizako ◽

Hisatoshi Araki ◽

Rika Yoshida ◽

Shinji Ando ◽

...

Keyword(s):

Portal Vein ◽

Liver Failure ◽

Indocyanine Green ◽

Portal Vein Embolization ◽

Clearance Rate ◽

Plasma Clearance ◽

Future Liver Remnant ◽

Liver Remnant

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Hepatocellular uptake index obtained with gadoxetate disodium-enhanced magnetic resonance imaging in the assessment future liver remnant function after major hepatectomy for biliary malignancy

BJS Open ◽

10.1093/bjsopen/zraa048 ◽

2021 ◽

Vol 5 (4) ◽

Author(s):

T Notake ◽

A Shimizu ◽

K Kubota ◽

T Ikehara ◽

H Hayashi ◽

...

Keyword(s):

Portal Vein ◽

Portal Vein Embolization ◽

Major Hepatectomy ◽

Multivariable Analysis ◽

Area Under The Curve ◽

Future Liver Remnant ◽

International Study ◽

Gadoxetate Disodium ◽

Liver Remnant ◽

Biliary Malignancy

Abstract Background Functional assessment of the future liver remnant (FLR) after major hepatectomy is essential but often difficult in patients with biliary malignancy, owing to obstructive jaundice and portal vein embolization. This study evaluated whether a novel index using gadoxetate disodium-enhanced MRI (EOB-MRI) could predict posthepatectomy liver failure (PHLF) after major hepatectomy for biliary malignancy. Methods The remnant hepatocellular uptake index (rHUI) was calculated in patients undergoing EOB-MRI before major hepatectomy for biliary malignancy. Receiver operating characteristic (ROC) curve analyses were used to evaluate the accuracy of rHUI for predicting PHLF grade B or C, according to International Study Group of Liver Surgery criteria. Multivariable logistic regression analyses comprised stepwise selection of parameters, including rHUI and other conventional indices. Results This study included 67 patients. The rHUI accurately predicted PHLF (area under the curve (AUC) 0.896). A cut-off value for rHUI of less than 0.410 predicted all patients who developed grade B or C PHLF. In multivariable analysis, only rHUI was an independent risk factor for grade B or C PHLF (odds ratio 2.0 × 103, 95 per cent c.i. 19.6 to 3.8 × 107; P < 0.001). In patients who underwent preoperative portal vein embolization, rHUI accurately predicted PHLF (AUC 0.885), whereas other conventional indices, such as the plasma disappearance rate of indocyanine green of the FLR and FLR volume, did not. Conclusion The rHUI is potentially a useful predictor of PHLF after major hepatectomy for biliary malignancy.

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

HPB ◽

10.1016/j.hpb.2020.04.439 ◽

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

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External biliary drainage following major liver resection for perihilar cholangiocarcinoma: impact on development of liver failure and biliary leakage

HPB ◽

10.1016/j.hpb.2015.11.007 ◽

2016 ◽

Vol 18 (4) ◽

pp. 348-353 ◽

Cited By ~ 21

Author(s):

Pim B. Olthof ◽

Robert J.S. Coelen ◽

Jimme K. Wiggers ◽

Marc G.H. Besselink ◽

Olivier R.C. Busch ◽

...

Keyword(s):

Liver Resection ◽

Liver Failure ◽

Biliary Drainage ◽

Perihilar Cholangiocarcinoma ◽

Major Liver Resection ◽

Biliary Leakage ◽

External Biliary Drainage

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Efficacy of Pre-Operative Portal Vein Embolization of Biliary Neoplasm before Major Hepatectomy

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.04.11843 ◽

2021 ◽

Vol 104 (4) ◽

pp. 583-590

Keyword(s):

Portal Vein ◽

Liver Failure ◽

Hepatic Resection ◽

Portal Vein Embolization ◽

Locally Advanced ◽

Liver Volume ◽

Future Liver Remnant ◽

Liver Remnant ◽

Major Hepatic Resection ◽

Biliary Neoplasm

Background: Malignant biliary neoplasm is relatively common in Southeast Asia. Portal vein embolization (PVE) is a preoperative procedure to induce hypertrophy of future liver remnants. PVE can decrease the rate of post hepatectomy liver failure (PHLF). Objective: To evaluate the efficacy of preoperative PVE of biliary neoplasm patient prior to major hepatic resection. Materials and Methods: The study included 53 patients with biliary neoplasm planned for major hepatic resection and that underwent PVE between July 2013 and August 2019. Liver volumetry before and after PVE was analyzed. Operative procedure and post hepatectomy outcome were evaluated. Results: Peri-hilar type cholangiocarcinoma, Bismuth-Corlette classification IIIA was the most frequent tumor. The technical success rate of PVE is 100%. Future liver remnant (FLR) volume after PVE was significantly increased from 379.1 to 460 mL (p<0.001). Post PVE FLR over total functional liver volume (TFLV) ratio was significantly increased from 27.8% to 34.6%(p<0.001). The mean kinetic growth rate (KGR) per week was 7.1%. Twenty-four patients underwent subsequent hepatectomy, and two patients presented with PHLF. Twenty-nine patients (54.7%) did not undergo subsequent hepatectomy as planned due to advanced disease with 21 (72.4%) because of locally advanced cancer, peritoneal carcinomatosis, and N2 lymph nodes metastasis), four (13.8%) that refused surgical treatment, and three (10.3%) that were loss to follow-up. Conclusion: Preoperative PVE before major hepatic resection in biliary neoplasm patients is an effective procedure to increase FLR, FLR/TFLV ratio, and provide good KGR. However, more than half of post preoperative PVE could not be obtained hepatectomy because of the progression to advanced stage of disease. Keywords: Biliary neoplasm, Portal vein embolization, Future liver remnant, Major hepatic resection, Post hepatectomy liver failure

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Portal vein embolization with n-butyl-cyanoacrylate before hepatectomy: a single-center retrospective analysis of 46 consecutive patients

Acta Radiologica ◽

10.1177/0284185120953802 ◽

2020 ◽

pp. 028418512095380

Author(s):

Marijela Moreno Berggren ◽

Bengt Isaksson ◽

Rickard Nyman ◽

Charlotte Ebeling Barbier

Keyword(s):

Liver Resection ◽

Portal Vein ◽

Local Anesthesia ◽

Portal Vein Embolization ◽

Liver Tumors ◽

Future Liver Remnant ◽

Liver Remnant ◽

Total Liver Volume ◽

Computed Tomography Images ◽

The Future

Background Preoperative portal vein embolization (PVE) is performed to induce hypertrophy of the future liver remnant enabling major liver resection in patients with various types of liver tumors. Purpose To evaluate safety and effectiveness of PVE with n-butyl-cyanoacrylate (NBCA). Material and Methods All consecutive patients referred to our hospital for PVE between July 2006 and July 2017 were retrospectively reviewed. Volumetry was performed on computed tomography images before and after PVE, segmenting the total liver volume and the future liver remnant (FLR), i.e. liver segments I–III. Results PVE was performed in 46 patients (18 women, 28 men; mean age = 61 years) using local anesthesia. The ipsilateral technique was used in 45 patients. Adverse events were rare. The mean FLR volume increase was 56%, the degree of hypertrophy was 9.7%, and the kinetic growth rate was 2.1%/week. The median ± SD period between PVE and liver surgery was 7 ± 3 weeks. Forty-two patients (91%) had surgery; liver resection was performed in 37 (80%) patients. Three patients (7%) developed transient liver failure after surgery. There was no 90-day post-PVE or postoperative mortality. Conclusion PVE using NBCA through the ipsilateral approach in local anesthesia is safe and effective in inducing hypertrophy of the future liver remnant enabling surgery, and thereby increasing survival in patients with liver tumors.

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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

10.21203/rs.3.rs-50168/v1 ◽

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).

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Oncological Outcomes after Liver Venous Deprivation for Colorectal Liver Metastases: A Single Center Experience

Cancers ◽

10.3390/cancers13020200 ◽

2021 ◽

Vol 13 (2) ◽

pp. 200

Author(s):

Salah Khayat ◽

Gianluca Cassese ◽

François Quenet ◽

Christophe Cassinotto ◽

Eric Assenat ◽

...

Keyword(s):

Portal Vein ◽

Liver Metastases ◽

Portal Vein Embolization ◽

Colorectal Liver Metastases ◽

Future Liver Remnant ◽

Small Sample ◽

Right Hepatectomy ◽

Liver Remnant ◽

Oncological Outcomes ◽

Extended Right Hepatectomy

Colorectal liver metastases (CRLM) are the major cause of death in patients with colorectal cancer (CRC). The cornerstone treatment of CRLM is surgical resection. Post-operative morbidity and mortality are mainly linked to an inadequate future liver remnant (FLR). Nowadays preoperative portal vein embolization (PVE) is the most widely performed technique to increase the size of the future liver remnant (FLR) before major hepatectomies. One method recently proposed to increase the FLR is liver venous deprivation (LVD), but its oncological impact is still unknown. The aim of this study is to report first short- and long-term oncological outcomes after LVD in patients undergoing right (or extended right) hepatectomy for CRLM. Seventeen consecutive patients undergoing LVD between July 2015 and May 2020 before an (extended) right hepatectomy were retrospectively analyzed from an institutional database. Post-operative and follow-up data were analyzed and reported. Primary outcomes were 1-year and 3-year overall survival (OS) and hepatic recurrence (HR). Postoperative complications occurred in 8 patients (47%). No deaths occurred after surgery. HR occurred in 9 patients (52.9%). 1-year and 3-year OS were 87% (95% confidence interval [CI]: ±16%) and 60.3%, respectively (95% CI: ±23%). Median Disease-Free Survival (DFS) was 6 months (CI 95%: 4.7–7.2). With all the limitations of a retrospective study with a small sample size, LVD showed similar oncological outcomes compared to literature reports for Portal Vein Embolization (PVE).

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