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.
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.
Authors: K P van Lienden; J W van den Esschert; W de Graaf; S Bipat; J S Lameris; T M van Gulik; O M van Delden Journal: Cardiovasc Intervent Radiol Date: 2012-07-18 Impact factor: 2.740
Authors: Kia Homayounfar; Torsten Liersch; Martin Niessner; Johannes Meller; Thomas Lorf; Heinz Becker; B Michael Ghadimi Journal: Langenbecks Arch Surg Date: 2010-03-07 Impact factor: 3.445
Authors: Michael Vouche; Robert J Lewandowski; Rohi Atassi; Khairuddin Memon; Vanessa L Gates; Robert K Ryu; Ron C Gaba; Mary F Mulcahy; Talia Baker; Kent Sato; Ryan Hickey; Daniel Ganger; Ahsun Riaz; Jonathan Fryer; Juan Carlos Caicedo; Michael Abecassis; Laura Kulik; Riad Salem Journal: J Hepatol Date: 2013-06-25 Impact factor: 25.083