Tumour growth after portal vein embolization with pre-procedural chemotherapy for colorectal liver metastases.
BACKGROUND
For resection of colorectal cancer (CRC) liver metastases, pre-operative portal vein embolization (PVE) is used to increase the size of the future liver remnant (FLR) prior to advanced liver resection when indicated. PVE is speculated to cause tumour progression, but only a limited number of studies have analysed tumour growth after PVE in the context of pre-procedural chemotherapy, which was the aim of this retrospective study.


METHODS
Patients treated with stabilizing chemotherapy and PVE before liver resection for CRC metastases were included. Tumour progression according to RECIST guidelines and a change in tumour volume was analysed on computed tomography (CT) scans prior to chemotherapy, before PVE and after PVE, respectively.


RESULTS
Thirty-four patients were included, of whom 23 had bilobar disease. Of tumours in the embolized lobe, 3/34 showed progression after PVE as compared with 3/23 in the non-embolized lobe (P = 0.677). A decrease in tumour volume of 16% and 11% was noted in the embolized and non-embolized lobe, respectively (P = 0.368). Patients were off chemotherapy in a median of 16 days before PVE. There was a linear correlation between the growth of tumours and time between the end of chemotherapy and PVE (r = 0.25, P = 0.0005).


CONCLUSIONS
The rate of progression of CRC liver metastases after PVE and pre-procedural chemotherapy was lower in the present study as compared with previous reports. This applies to tumours in both the embolized and non-embolized lobes and is associated with keeping the time between the end of chemotherapy and PVE short.
Department of Clinical Sciences, Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden.
Lidewij
L
Spelt
Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Ernesto
E
Sparrelid
Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Bengt
B
Isaksson
Department of Clinical Sciences, Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden.
Roland G
RG
Andersson
Department of Clinical Sciences, Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden.
Christian
C
Sturesson
D000368:Aged; D000369:Aged, 80 and over; D049109:Cell Proliferation; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006498:Hepatectomy; D006801:Humans; D016014:Linear Models; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods*; D011169:Portal Vein; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden