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. 2006 Jul;244(1):71-9.
doi: 10.1097/01.sla.0000217609.26178.35.

Right portal vein embolization before right hepatectomy for unilobar colorectal liver metastases reduces the intrahepatic recurrence rate

Elie Oussoultzoglou  1 , Philippe Bachellier, Edoardo Rosso, Radu Scurtu, Ioan Lucescu, Michel Greget, Daniel Jaeck
Affiliations

Right portal vein embolization before right hepatectomy for unilobar colorectal liver metastases reduces the intrahepatic recurrence rate

Elie Oussoultzoglou et al. Ann Surg. 2006 Jul.

Abstract

Aim: To assess the effect of portal vein embolization (PVE) on intrahepatic recurrence rate after right hepatectomy for unilobar colorectal liver metastases (CLM).

Summary and background: Recent research suggests that CLM could spread retrogradely through the portal vein. PVE may reduce tumor shedding by the occlusion of distal portal branches. However, no study reported the clinical effect of PVE on intrahepatic recurrence after CLM resection.

Patients and methods: Between 1995 and 2003, 44 patients requiring a right hepatectomy for unilobar CLM were operated in our institution. Right hepatectomy was performed after PVE in 23 patients (group A) and without PVE in 21 (group B). Surgical outcome and site of recurrence were analyzed.

Results: The postoperative mortality was nil. Overall morbidity and transitory liver failure rates were similar in groups A and B (43.4% and 17.3% vs. 33.3% and 14.2%, respectively). The 3- and 5-year overall survival rates did not differ in group A and B patients (61.2% and 43.7% vs. 49.7% and 35.5%, respectively; P = 0.862). The disease-free survival rate was similar in both groups. Thirty patients (68.2%) developed recurrences. Recurrences were intrahepatic in 22 patients (50%) and extrahepatic in 27 (61.3%). Intrahepatic recurrence rate was significantly lower in group A compared with group B (26.0% vs. 76.1% respectively; P < 0.001). PVE, number of CLM, and administration of neoadjuvant chemotherapy were independent prognostic factors for intrahepatic recurrences.

Conclusion: This study showed that PVE reduces intrahepatic recurrence rate after right hepatectomy for unilobar CLM.

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Figures

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FIGURE 1. Selection of the study population. *Including 4 patients (with PVE in 3) considered preoperatively as unilobar disease; in all of them, a curative resection has been performed. †Includes mono-, bi-, and trisegmentectomies and wedge resections. Values are number of patients.
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FIGURE 2. Kaplan-Meier cumulative risk of intrahepatic and extrahepatic disease recurrence after right hepatectomy for unilobar colorectal liver metastases. Note that 81.8% and 74.0%, respectively, of these recurrences occurred within 18 months after hepatectomy.
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References

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