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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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Kaplan-Meier disease-free and overall survival curves of the PVE group (n = 34) and the control group (n = 102). Disease-free survival, PVE versus control: p = 0.335; overall survival, PVE versus control: p = 0.221 (log-rank test)
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Fig2: Kaplan-Meier disease-free and overall survival curves of the PVE group (n = 34) and the control group (n = 102). Disease-free survival, PVE versus control: p = 0.335; overall survival, PVE versus control: p = 0.221 (log-rank test)

Mentions: The mean follow-up period in the two groups was 35 months (standard deviation, 25 months). Overall, 14 (41%) patients in the PVE group developed recurrence, compared to 54 (53%) in the control group (p = 0.322). Extrahepatic recurrence was detected in 10 (29%) and 41 (40%) cases in the PVE group and the control group, respectively (p = 0.310). Intrahepatic recurrence was detected in 10 (29%) of the PVE patients and 47 (46%) of the control patients (p = 0.109). There was no difference in the timing of detection of recurrence. Fourteen (41%) of the recurrence cases in the PVE group and 43 (42%) in the control group were detected before one year (p = 1.000). The median disease-free survival in the PVE group was 14 months (range: 1.9–94 months), and that in the control group was 13 months (range: 1–88 months). Figure 2 shows the disease-free survival and overall survival of the two groups. The 1-, 3-, and 5-year disease-free survival rates were 57, 29, and 26% respectively, in the control group and 60, 42, and 42%, respectively, in the PVE group (log-rank, p = 0.335).Fig. 2


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)

Kaplan-Meier disease-free and overall survival curves of the PVE group (n = 34) and the control group (n = 102). Disease-free survival, PVE versus control: p = 0.335; overall survival, PVE versus control: p = 0.221 (log-rank test)
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Related In: Results  -  Collection

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

Fig2: Kaplan-Meier disease-free and overall survival curves of the PVE group (n = 34) and the control group (n = 102). Disease-free survival, PVE versus control: p = 0.335; overall survival, PVE versus control: p = 0.221 (log-rank test)
Mentions: The mean follow-up period in the two groups was 35 months (standard deviation, 25 months). Overall, 14 (41%) patients in the PVE group developed recurrence, compared to 54 (53%) in the control group (p = 0.322). Extrahepatic recurrence was detected in 10 (29%) and 41 (40%) cases in the PVE group and the control group, respectively (p = 0.310). Intrahepatic recurrence was detected in 10 (29%) of the PVE patients and 47 (46%) of the control patients (p = 0.109). There was no difference in the timing of detection of recurrence. Fourteen (41%) of the recurrence cases in the PVE group and 43 (42%) in the control group were detected before one year (p = 1.000). The median disease-free survival in the PVE group was 14 months (range: 1.9–94 months), and that in the control group was 13 months (range: 1–88 months). Figure 2 shows the disease-free survival and overall survival of the two groups. The 1-, 3-, and 5-year disease-free survival rates were 57, 29, and 26% respectively, in the control group and 60, 42, and 42%, respectively, in the PVE group (log-rank, p = 0.335).Fig. 2

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