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Role of portal vein embolization in hepatocellular carcinoma management and its effect on recurrence: a case-control study.

Siriwardana RC, Lo CM, Chan SC, Fan ST - World J Surg (2012)

Bottom Line: Liver regeneration that occurs after portal vein embolization (PVE) may have adverse effects on the microscopic tumor foci in the residual liver mass in patients with hepatocellular carcinoma (HCC).When the two groups were compared, minor (PVE, 24%; control, 29%; p = 0.651) and major (PVE, 18%; control, 15%; p = 0.784) complications were similar.On multivariate analysis, PVE was not a factor affecting survival (p = 0.821).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, People's Republic of China.

ABSTRACT

Background: Liver regeneration that occurs after portal vein embolization (PVE) may have adverse effects on the microscopic tumor foci in the residual liver mass in patients with hepatocellular carcinoma (HCC).

Methods: Fifty-four HCC patients with inadequate functional residual liver volume were offered PVE during a seven-year period. Among them, 34 (63%) patients underwent curative resection. They were compared with a matched control group (n = 102) who underwent surgery without PVE. Postoperative complications, pattern of recurrence, and survival were compared between groups.

Results: In the PVE group, a pre-embolization functional residual liver volume of 23% (12-33.5%) improved to 34% (20-54%) (p = 0.005) at the time of surgery. When the two groups were compared, minor (PVE, 24%; control, 29%; p = 0.651) and major (PVE, 18%; control, 15%; p = 0.784) complications were similar. After a follow-up period of 35 months (standard deviation 25 months), extrahepatic recurrences were detected in 10 PVE patients (29%) and 41 control patients (40%) (p = 0.310). Intrahepatic recurrences were seen in 10 (29%) and 47 (46%) cases (p = 0.109) in the PVE and control groups, respectively. In the PVE group, 41% (n = 14) of the recurrences were detected before one year, compared with 42% (n = 43) in the control group (p = 1). Disease-free survival rates at 1, 3, and 5 years were 57, 29, and 26% in the control group and 60, 42, and 42% in the PVE group (log-rank, p = 0.335). On multivariate analysis, PVE was not a factor affecting survival (p = 0.821).

Conclusions: Portal vein embolization increases the resectability of initially unresectable HCC due to inadequate functional residual liver volume, and it has no deleterious oncological effect after major resection of HCC.

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Treatment flowchart of the 54 patients who underwent portal vein embolization (PVE)
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Fig1: Treatment flowchart of the 54 patients who underwent portal vein embolization (PVE)

Mentions: Resection was not feasible in 20 (37%) patients. In 10 (18.5%) patients, increase of the FRLV was considered inadequate. In 4 of them, the decision against resection was taken during surgery despite apparently adequate FRLV on the preoperative radiological assessment. In the other 10 patients, surgery was considered not to be feasible due to (1) deteriorated liver function test results in three (5.5%), (2) development of extrahepatic metastasis in three (5.5%), (3) macroscopically grossly cirrhotic liver or extensive varices in two (3.7%), (4) progression of the primary tumor in one (2%), and (5) tumor rupture in one (Fig. 1). Thirty-four (63%) patients underwent curative resection. There were two (3.7%) hospital deaths; one patient died from liver failure and the other developed sepsis and subsequent liver failure. Overall, with the combination of PVE and surgery, 32/54 (60%) of the patients were able to achieve long-term survival (Fig. 1).Fig. 1


Role of portal vein embolization in hepatocellular carcinoma management and its effect on recurrence: a case-control study.

Siriwardana RC, Lo CM, Chan SC, Fan ST - World J Surg (2012)

Treatment flowchart of the 54 patients who underwent portal vein embolization (PVE)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3368111&req=5

Fig1: Treatment flowchart of the 54 patients who underwent portal vein embolization (PVE)
Mentions: Resection was not feasible in 20 (37%) patients. In 10 (18.5%) patients, increase of the FRLV was considered inadequate. In 4 of them, the decision against resection was taken during surgery despite apparently adequate FRLV on the preoperative radiological assessment. In the other 10 patients, surgery was considered not to be feasible due to (1) deteriorated liver function test results in three (5.5%), (2) development of extrahepatic metastasis in three (5.5%), (3) macroscopically grossly cirrhotic liver or extensive varices in two (3.7%), (4) progression of the primary tumor in one (2%), and (5) tumor rupture in one (Fig. 1). Thirty-four (63%) patients underwent curative resection. There were two (3.7%) hospital deaths; one patient died from liver failure and the other developed sepsis and subsequent liver failure. Overall, with the combination of PVE and surgery, 32/54 (60%) of the patients were able to achieve long-term survival (Fig. 1).Fig. 1

Bottom Line: Liver regeneration that occurs after portal vein embolization (PVE) may have adverse effects on the microscopic tumor foci in the residual liver mass in patients with hepatocellular carcinoma (HCC).When the two groups were compared, minor (PVE, 24%; control, 29%; p = 0.651) and major (PVE, 18%; control, 15%; p = 0.784) complications were similar.On multivariate analysis, PVE was not a factor affecting survival (p = 0.821).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, People's Republic of China.

ABSTRACT

Background: Liver regeneration that occurs after portal vein embolization (PVE) may have adverse effects on the microscopic tumor foci in the residual liver mass in patients with hepatocellular carcinoma (HCC).

Methods: Fifty-four HCC patients with inadequate functional residual liver volume were offered PVE during a seven-year period. Among them, 34 (63%) patients underwent curative resection. They were compared with a matched control group (n = 102) who underwent surgery without PVE. Postoperative complications, pattern of recurrence, and survival were compared between groups.

Results: In the PVE group, a pre-embolization functional residual liver volume of 23% (12-33.5%) improved to 34% (20-54%) (p = 0.005) at the time of surgery. When the two groups were compared, minor (PVE, 24%; control, 29%; p = 0.651) and major (PVE, 18%; control, 15%; p = 0.784) complications were similar. After a follow-up period of 35 months (standard deviation 25 months), extrahepatic recurrences were detected in 10 PVE patients (29%) and 41 control patients (40%) (p = 0.310). Intrahepatic recurrences were seen in 10 (29%) and 47 (46%) cases (p = 0.109) in the PVE and control groups, respectively. In the PVE group, 41% (n = 14) of the recurrences were detected before one year, compared with 42% (n = 43) in the control group (p = 1). Disease-free survival rates at 1, 3, and 5 years were 57, 29, and 26% in the control group and 60, 42, and 42% in the PVE group (log-rank, p = 0.335). On multivariate analysis, PVE was not a factor affecting survival (p = 0.821).

Conclusions: Portal vein embolization increases the resectability of initially unresectable HCC due to inadequate functional residual liver volume, and it has no deleterious oncological effect after major resection of HCC.

Show MeSH
Related in: MedlinePlus