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Comparative Study
. 2013 Dec;100(13):1777-83.
doi: 10.1002/bjs.9317.

Portal vein embolization improves rate of resection of extensive colorectal liver metastases without worsening survival

J Shindoh  1 , C-W D Tzeng, T A Aloia, S A Curley, G Zimmitti, S H Wei, S Y Huang, S Gupta, M J Wallace, J-N Vauthey
Affiliations
Comparative Study

Portal vein embolization improves rate of resection of extensive colorectal liver metastases without worsening survival

J Shindoh et al. Br J Surg. 2013 Dec.

Abstract

Background: Most patients requiring an extended right hepatectomy (ERH) have an inadequate standardized future liver remnant (sFLR) and need preoperative portal vein embolization (PVE). However, the clinical and oncological impact of PVE in such patients remains unclear.

Methods: All consecutive patients presenting at the M. D. Anderson Cancer Center with colorectal liver metastases (CLM) requiring ERH at presentation from 1995 to 2012 were studied. Surgical and oncological outcomes were compared between patients with adequate and inadequate sFLRs at presentation.

Results: Of the 265 patients requiring ERH, 126 (47·5 per cent) had an adequate sFLR at presentation, of whom 123 underwent a curative resection. Of the 139 patients (52·5 per cent) who had an inadequate sFLR and underwent PVE, 87 (62·6 per cent) had a curative resection. Thus, the curative resection rate was increased from 46·4 per cent (123 of 265) at baseline to 79·2 per cent (210 of 265) following PVE. Among patients who underwent ERH, major complication and 90-day mortality rates were similar in the no-PVE and PVE groups (22·0 and 4·1 per cent versus 31 and 7 per cent respectively); overall and disease-free survival rates were also similar in these two groups. Of patients with an inadequate sFLR at presentation, those who underwent ERH had a significantly better median overall survival (50·2 months) than patients who had non-curative surgery (21·3 months) or did not undergo surgery (24·7 months) (P = 0·002).

Conclusion: PVE enabled curative resection in two-thirds of patients with CLM who had an inadequate sFLR and were unable to tolerate ERH at presentation. Patients who underwent curative resection after PVE had overall and disease-free survival rates equivalent to those of patients who did not need PVE.

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Figures

Figure 1
Figure 1
Clinical outcomes of 265 patients with potentially resectable colorectal liver metastases at presentation. Abbreviations. sFLR, Standardized future liver remnant; PVE, portal vein embolization.
Figure 2
Figure 2
Long-term survival outcomes in patients with colorectal liver metastases. A and B. Overall (A) and disease-free survival rates (B) in patients treated with extended right hepatectomy (ERH) without portal vein embolization (PVE) and after PVE. (C) Overall survival rates in patients who underwent PVE according to surgical treatment.
Figure 2
Figure 2
Long-term survival outcomes in patients with colorectal liver metastases. A and B. Overall (A) and disease-free survival rates (B) in patients treated with extended right hepatectomy (ERH) without portal vein embolization (PVE) and after PVE. (C) Overall survival rates in patients who underwent PVE according to surgical treatment.
Figure 2
Figure 2
Long-term survival outcomes in patients with colorectal liver metastases. A and B. Overall (A) and disease-free survival rates (B) in patients treated with extended right hepatectomy (ERH) without portal vein embolization (PVE) and after PVE. (C) Overall survival rates in patients who underwent PVE according to surgical treatment.
See this image and copyright information in PMC

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