Long-term survival and disease recurrence following portal vein embolisation prior to major hepatectomy for colorectal metastases.
BACKGROUND
Portal vein embolisation (PVE) can be used to increase the remnant liver parenchyma volume before major hepatectomy but may stimulate tumour growth. The pattern of disease recurrence and long-term survival has not been adequately addressed.


METHODS
Over a period of 7 years 36 patients underwent preoperative PVE before resection of four or more liver segments for colorectal cancer (CRC) liver metastases. PVE was performed when the future liver remnant (FLR) assessed by magnetic resonance imaging (MRI) scan volumetry was less than 30%. Disease-free and overall survival was compared with a control group (65 patients) undergoing extended right/right hepatectomy for CRC metastases without PVE during the same time period.


RESULTS
PVE was successful in all patients. PVE increased the median FLR volume by 37% [295 ml (22%) to 404 ml (32%), p < 0.0001]. 61% of patients undergoing PVE proceeded to liver resection (n = 22). Twelve patients (33%) developed disease progression following PVE. The 5-year survival after liver resection with PVE was 25%, compared with 50% without PVE. The 5-year disease-free survival was 30% post PVE and 50% without PVE.


CONCLUSIONS
We conclude that PVE significantly increases the future liver remnant. Only two-thirds of patients proceed to resection because of disease progression. Long-term survival is less than in patients who do not require PVE. The effect of PVE on tumour growth requires investigation.
Pamecha
Viniyendra
V
Hepato-Pancreatico-Biliary and Liver Transplant Surgery, Royal Free Hospital and University College Medical School, University College London, London, UK. Viniyendra.Pamecha@royalfree.nhs.uk
Glantzounis
Georgios
G
Davies
Niel
N
Fusai
Giuseppe
G
Sharma
Dinesh
D
Davidson
Brian
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011169:Portal Vein; D011300:Preoperative Care; D016019:Survival Analysis
D000970:Antineoplastic Agents