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01-06-2017 | Hepatobiliary Tumors

Efficacy of Preoperative Portal Vein Embolization Among Patients with Hepatocellular Carcinoma, Biliary Tract Cancer, and Colorectal Liver Metastases: A Comparative Study Based on Single-Center Experience of 319 Cases

Authors: Suguru Yamashita, MD, PhD, Yoshihiro Sakamoto, MD, PhD, Satoshi Yamamoto, MD, PhD, Nobuyuki Takemura, MD, PhD, Kiyohiko Omichi, MD, PhD, Hiroji Shinkawa, MD, PhD, Kazuhiro Mori, MD, Junichi Kaneko, MD, PhD, Nobuhisa Akamatsu, MD, PhD, Junichi Arita, MD, PhD, Kiyoshi Hasegawa, MD, PhD, Norihiro Kokudo, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2017

Abstract

Background

Efficacy of preoperative portal vein embolization (PVE) has been established; however, differences of outcomes among diseases, including hepatocellular carcinoma (HCC), biliary tract cancer (BTC), and colorectal liver metastases (CLM), are unclear.

Methods

Subjects included patients in a prospectively collected database undergoing PVE (from 1995 to 2013). A future liver remnant (FLR) volume ≥40% is the minimal requirement for patients with an indocyanine green retention rate at 15 min (ICGR15) <10%, and stricter criteria (FLR volume ≥50%) have been applied for patients with 20% > ICGR15 ≥ 10%. Patient characteristics and survivals were compared among those three diseases, and predictors of dropout and better FLR hypertrophy were determined.

Results

In 319 consecutive patients undergoing PVE for HCC (n = 70), BTC (n = 172), and CLM (n = 77), the degree of hypertrophy did not significantly differ by cancer types (median 10, 9.6, and 10%, respectively). Eighty percent (256 of 319) of patients completed subsequent hepatectomy after a median waiting interval of 24 days (range 5–90), while dropout after PVE was more common in BTC or CLM (odds ratio 2.75, p = 0.018), mainly because of disease progression. Ninety-day liver-related mortality after hepatectomy was 0% in the entire cohort, and 5-year overall survival of patients with HCC, BTC, and CLM was 56, 50, and 51%, respectively (p = 0.948). No patients who dropped out survived more than 2.5 years after PVE.

Conclusion

PVE produced equivalent FLR hypertrophy among the three diseases as long as liver function was fulfilling the preset criteria; however, the completion rate of subsequent hepatectomy was highest in HCC. PVE followed by hepatectomy was a safe and feasible strategy for otherwise unresectable disease irrespective of cancer types.

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Title: Efficacy of Preoperative Portal Vein Embolization Among Patients with Hepatocellular Carcinoma, Biliary Tract Cancer, and Colorectal Liver Metastases: A Comparative Study Based on Single-Center Experience of 319 Cases
Authors: Suguru Yamashita, MD, PhD
Yoshihiro Sakamoto, MD, PhD
Satoshi Yamamoto, MD, PhD
Nobuyuki Takemura, MD, PhD
Kiyohiko Omichi, MD, PhD
Hiroji Shinkawa, MD, PhD
Kazuhiro Mori, MD
Junichi Kaneko, MD, PhD
Nobuhisa Akamatsu, MD, PhD
Junichi Arita, MD, PhD
Kiyoshi Hasegawa, MD, PhD
Norihiro Kokudo, MD, PhD
Publication date: 01-06-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-5800-z

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Efficacy of Preoperative Portal Vein Embolization Among Patients with Hepatocellular Carcinoma, Biliary Tract Cancer, and Colorectal Liver Metastases: A Comparative Study Based on Single-Center Experience of 319 Cases

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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