J Heil1,2, R Korenblik3,4, F Heid1,5, W O Bechstein2, M Bemelmans4, C Binkert6, B Björnsson7, S Breitenstein5, O Detry8, A Dili9, R F Dondelinger10, L Gerard10, T Giménez-Maurel11, B Guiu12, D Heise13, M Hertl14, J A Kalil14, J J Klein14, A Lakoma15, U P Neumann13, B Olij4, S G Pappas14, P Sandström7, A Schnitzbauer2, A Serrablo11, J Tasse16, C Van der Leij17, P Metrakos15, R Van Dam3,4,13, E Schadde1,5,14. 1. Institute of Physiology, University of Zurich, Zurich, Switzerland. 2. Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany. 3. GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands. 4. Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands. 5. Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland. 6. Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland. 7. Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. 8. Department of Abdominal Surgery and Transplantation, University of Liege, Centre Hospitalier Universitaire de Liege, Liege, Belgium. 9. Department of Abdominal Surgery, Centre Hospitalier Universitaire Dinant Godinne Saint-Elisabeth - UCL-Namur, Yvoir, Belgium. 10. Department of Imaging, University Hospital Liege, Liege, Belgium. 11. Department of Surgery, Miguel University Hospital and University of Zaragoza, Zaragoza, Spain. 12. Department of Radiology, St Eloi University Hospital, Montpellier, France. 13. Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany. 14. Department of Surgery, Rush University Medical Center, Chicago, Illinois, USA. 15. Department of Surgery, Section of Hepato-Pancreatico-Biliary Surgery, McGill University Health Center, Montreal, Quebec, Canada. 16. Department of Radiology, Rush University Medical Center, Chicago, USA. 17. Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
Abstract
BACKGROUND: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability. METHODS: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis. RESULTS: In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders. CONCLUSION: PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.
BACKGROUND: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability. METHODS: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis. RESULTS: In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders. CONCLUSION: PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.
Authors: E Schadde; R M van Dam; R Korenblik; B Olij; L A Aldrighetti; M Abu Hilal; M Ahle; B Arslan; L J van Baardewijk; I Baclija; C Bent; C L Bertrand; B Björnsson; M T de Boer; S W de Boer; R P H Bokkers; I H M Borel Rinkes; S Breitenstein; R C G Bruijnen; P Bruners; M W Büchler; J C Camacho; A Cappelli; U Carling; B K Y Chan; D H Chang; J Choi; J Codina Font; M Crawford; D Croagh; E Cugat; R Davis; D W De Boo; F De Cobelli; J F De Wispelaere; O M van Delden; M Delle; O Detry; R Díaz-Nieto; A Dili; J I Erdmann; O Fisher; C Fondevila; Å Fretland; F Garcia Borobia; A Gelabert; L Gérard; F Giuliante; P D Gobardhan; F Gómez; T Grünberger; D J Grünhagen; J Guitart; J Hagendoorn; J Heil; D Heise; E Herrero; G F Hess; M H Hoffmann; R Iezzi; F Imani; J Nguyen; E Jovine; J C Kalff; G Kazemier; T P Kingham; J Kleeff; O Kollmar; W K G Leclercq; S Lopez Ben; V Lucidi; A MacDonald; D C Madoff; S Manekeller; G Martel; A Mehrabi; H Mehrzad; M R Meijerink; K Menon; P Metrakos; C Meyer; A Moelker; S Modi; N Montanari; J Navines; U P Neumann; P Peddu; J N Primrose; X Qu; D Raptis; F Ratti; F Ridouani; C Rogan; U Ronellenfitsch; S Ryan; C Sallemi; J Sampere Moragues; P Sandström; L Sarriá; A Schnitzbauer; M Serenari; A Serrablo; M L J Smits; E Sparrelid; E Spüntrup; G A Stavrou; R P Sutcliffe; I Tancredi; J C Tasse; V Udupa; D Valenti; Y Fundora; T J Vogl; X Wang; S A White; W A Wohlgemuth; D Yu; I A J Zijlstra; C A Binkert; M H A Bemelmans; C van der Leij Journal: Cardiovasc Intervent Radiol Date: 2022-07-05 Impact factor: 2.797
Authors: Radoslava Stoyanova; Helmut Kopf; Wolfgang Schima; Wolfgang Karl Matzek; Alexander Klaus Journal: Explor Target Antitumor Ther Date: 2022-02-28