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Comparative Study
. 2024 Apr 3;111(4):znae087.
doi: 10.1093/bjs/znae087.

Liver regeneration after portal and hepatic vein embolization improves overall survival compared with portal vein embolization alone: mid-term survival analysis of the multicentre DRAGON 0 cohort

Remon Korenblik  1   2 , Jan Heil  3   4 , Jens Smits  1   2 , Sinead James  1   2 , Bram Olij  1   2 , Wolf O Bechstein  4 , Marc H A Bemelmans  2   5 , Christoph A Binkert  6 , Stefan Breitenstein  7 , Michael Williams  8 , Olivier Detry  9 , Maxime J L Dewulf  2   5 , Alexandra Dili  10 , Lukasz F Grochola  7 , Jon Grote  5 , Daniel Heise  5   11 , Jennifer A Kalil  12 , Peter Metrakos  12 , Ulf P Neumann  2   5   11 , Sam G Pappas  8 , Francesca Pennetta  1   2 , Andreas A Schnitzbauer  4 , Jordan C Tasse  13 , Bjorn Winkens  14 , Steven W M Olde Damink  2   5   15 , Christiaan van der Leij  1   16 , Erik Schadde  3   8   17   18 , Ronald M van Dam  1   2   5 ; DRAGON trials collaborative
Collaborators, Affiliations
Comparative Study

Liver regeneration after portal and hepatic vein embolization improves overall survival compared with portal vein embolization alone: mid-term survival analysis of the multicentre DRAGON 0 cohort

Remon Korenblik et al. Br J Surg. .

Abstract

Background: The purpose of this study was to compare 3-year overall survival after simultaneous portal (PVE) and hepatic vein (HVE) embolization versus PVE alone in patients undergoing liver resection for primary and secondary cancers of the liver.

Methods: In this multicentre retrospective study, all DRAGON 0 centres provided 3-year follow-up data for all patients who had PVE/HVE or PVE, and were included in DRAGON 0 between 2016 and 2019. Kaplan-Meier analysis was undertaken to assess 3-year overall and recurrence/progression-free survival. Factors affecting survival were evaluated using univariable and multivariable Cox regression analyses.

Results: In total, 199 patients were included from 7 centres, of whom 39 underwent PVE/HVE and 160 PVE alone. Groups differed in median age (P = 0.008). As reported previously, PVE/HVE resulted in a significantly higher resection rate than PVE alone (92 versus 68%; P = 0.007). Three-year overall survival was significantly higher in the PVE/HVE group (median survival not reached after 36 months versus 20 months after PVE; P = 0.004). Univariable and multivariable analyses identified PVE/HVE as an independent predictor of survival (univariable HR 0.46, 95% c.i. 0.27 to 0.76; P = 0.003).

Conclusion: Overall survival after PVE/HVE is substantially longer than that after PVE alone in patients with primary and secondary liver tumours.

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Figures

Fig. 1
Fig. 1
Study flow chart PVE, portal vein embolization; HVE, hepatic vein embolization; PVL portal vein ligation; ALPPS, associating liver partition and portal vein ligation for staged hepatectomy.
Fig. 2
Fig. 2
Overall survival, and progression-free survival among patients who underwent resection (total group) a Overall survival, and b progression-free survival among patients who underwent resection. PVE, portal vein embolization; HVE, hepatic vein embolization. a  P = 0.004, b  P = 0.088 (log rank test).
See this image and copyright information in PMC

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