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. 2020 Jul;27(7):2311-2318.
doi: 10.1245/s10434-020-08258-3. Epub 2020 Feb 26.

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

Pim B Olthof  1   2 , Luca Aldrighetti  3 , Ruslan Alikhanov  3   4 , Matteo Cescon  5 , Bas Groot Koerkamp  6 , William R Jarnagin  7 , Silvio Nadalin  8 , Johann Pratschke  9 , Moritz Schmelze  9 , Ernesto Sparrelid  10 , Hauke Lang  11 , Alfredo Guglielmi  12 , Thomas M van Gulik  13 ; Perihilar Cholangiocarcinoma Collaboration Group
Collaborators, Affiliations

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

Pim B Olthof et al. Ann Surg Oncol. 2020 Jul.

Erratum in

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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Conflict of interest statement

Pim B. Olthof, Luca Aldrighetti, Ruslan Alikhanov, Matteo Cescon, Bas Groot Koerkamp, William R. Jarnagin, Silvio Nadalin, Johann Pratschke, Moritz Schmelze, Ernesto Sparrelid, Hauke Lang, Alfredo Guglielmi, and Thomas M. van Gulik have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
a Differential use of PVE across institutions with at least 15 included cases. The dotted line represents the use of PVE in the entire cohort. b Use of PVE per year in the cohort. PVE portal vein embolization
See this image and copyright information in PMC

References

    1. Narula N, Aloia TA. Portal vein embolization in extended liver resection. Langenbecks Arch Surg. 2017;402(5):727–735. doi: 10.1007/s00423-017-1591-8. - DOI - PubMed
    1. Glantzounis GK, Tokidis E, Basourakos SP, Ntzani EE, Lianos GD, Pentheroudakis G. The role of portal vein embolization in the surgical management of primary hepatobiliary cancers. A systematic review. Eur J Surg Oncol. 2017;43(1):32–41. doi: 10.1016/j.ejso.2016.05.026. - DOI - PubMed
    1. Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery. 1990;107(5):521–527. - PubMed
    1. Shindoh J, Tzeng CW, Aloia TA, et al. Safety and efficacy of portal vein embolization before planned major or extended hepatectomy: an institutional experience of 358 patients. J Gastrointest Surg. 2014;18(1):45–51. doi: 10.1007/s11605-013-2369-0. - DOI - PubMed
    1. van Lienden KP, van den Esschert JW, de Graaf W, et al. Portal vein embolization before liver resection: a systematic review. Cardiovasc Intervent Radiol. 2013;36(1):25–34. doi: 10.1007/s00270-012-0440-y. - DOI - PMC - PubMed