Top

Published in:

01-12-2007 | Hepatic and Pancreatic Tumors

Preoperative Portal Vein Embolization and Surgical Resection in Patients with Hepatocellular Carcinoma and Small Future Liver Remnant Volume: Comparison with Transarterial Chemoembolization

Authors: Dong Dae Seo, MD, Han Chu Lee, MD, Myoung Kuk Jang, MD, Hyun Ju Min, MD, Kang Mo Kim, MD, Young Suk Lim, MD, Young-Hwa Chung, MD, Yung Sang Lee, MD, Dong Jin Suh, MD, Gi-Young Ko, MD, Young-Joo Lee, MD, Sung-Gyu Lee, MD

Published in: Annals of Surgical Oncology | Issue 12/2007

Abstract

Background

Preoperative portal vein embolization (PVE) increases the future liver remnant (FLR) volume, thus enabling surgical resection in patients with small FLR volume. It is unclear, however, if this approach can enhance survival in patients with hepatocellular carcinoma (HCC). We therefore compared the outcomes of preoperative PVE and surgical resection with transarterial chemoembolization (TACE).

Methods

Changes in FLR volumes were analyzed in 32 HCC patients who underwent preoperative PVE and surgical resection. Long-term outcomes were compared with 64 TACE-treated patients matched for gender, Child-Turcotte-Pugh class, tumor size and number, serum alpha-fetoprotein levels, and UICC stage.

Results

In the PVE group, the baseline ratio of FLR/total estimated liver volumes (TELV) was 27.6 ± 7.2%. Following PVE, FLR volume increased 34% (336.5 vs 449.4 mL, P < .001) and the ratio of FLR/TELV increased from 27.6 ± 7.2 to 36.9 ± 8.1% (P < .001). There was no mortality associated with PVE or surgical resection. The 5-year survival rate was significantly higher in the PVE group than in the TACE group (71.9% vs 45.6%, P = .03). Multivariate analysis showed that treatment modality was an independent predictive factor for survival (odds ratio 2.05, 95% confidence interval 1.01–4.16, P = .046).

Conclusions

Preoperative PVE enables surgical resection in HCC patients with small FLR volume and improves patient survival compared with TACE.

Fazakas J, Mandli T, Ther G, et al. Evaluation of liver function for hepatic resection. Transplant Proc 2006; 38(3):798–800PubMedCrossRef

Shirabe K, Shimada M, Gion T, et al. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg 1999; 188(3):304–9PubMedCrossRef

Madoff DC, Hicks ME, Vauthey JN, et al. Transhepatic portal vein embolization: anatomy, indications, and technical considerations. Radiographics 2002; 22(5):1063–76PubMed

Shoup M, Gonen M, D’Angelica M, et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg 2003; 7(3):325–30PubMedCrossRef

Abdalla EK, Hicks ME, Vauthey JN. Portal vein embolization: rationale, technique and future prospects. Br J Surg 2001; 88(2):165–75PubMedCrossRef

Kinoshita H, Sakai K, Hirohashi K, Igawa S, Yamasaki O, Kubo S. Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg 1986; 10(5):803–8PubMedCrossRef

Lee KC, Kinoshita H, Hirohashi K, Kubo S, Iwasa R. Extension of surgical indications for hepatocellular carcinoma by portal vein embolization. World J Surg 1993; 17(1):109–15PubMedCrossRef

Kawasaki S, Makuuchi M, Kakazu T, et al. Resection for multiple metastatic liver tumors after portal embolization. Surgery 1994; 115(6):674–7PubMed

de Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V. Preoperative portal vein embolization for extension of hepatectomy indications. Hepatology 1996; 24(6):1386–91PubMedCrossRef

10.

Farges O, Belghiti J, Kianmanesh R, et al. Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 2003; 237(2):208–17PubMedCrossRef

11.

Ko GY, Sung KB, Yoon HK, Kim JH, Weon YC, Song HY. Preoperative portal vein embolization with a new liquid embolic agent. Radiology 2003; 227(2):407–13PubMedCrossRef

12.

Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 2002; 137(6):675–80; discussion 680–1PubMedCrossRef

13.

Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990; 107(5):521–7PubMed

14.

Nagino M, Nimura Y, Kamiya J, et al. Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma. Surgery 1995; 117(6):677–81PubMedCrossRef

15.

Wakabayashi H, Ishimura K, Okano K, et al. Is preoperative portal vein embolization effective in improving prognosis after major hepatic resection in patients with advanced-stage hepatocellular carcinoma? Cancer 2001; 92(9):2384–90PubMedCrossRef

16.

Llovet JM, Sala M. Non-surgical therapies of hepatocellular carcinoma. Eur J Gastroenterol Hepatol 2005; 17(5):505–13PubMedCrossRef

17.

Matsui O, Kadoya M, Yoshikawa J, Gabata T, Takashima T, Demachi H. Subsegmental transcatheter arterial embolization for small hepatocellular carcinomas: local therapeutic effect and 5-year survival rate. Cancer Chemother Pharmacol 1994; 33 Suppl:S84–8PubMedCrossRef

18.

Huang YH, Wu JC, Chau GY, et al. Supportive treatment, resection and transcatheter arterial chemoembolization in resectable hepatocellular carcinoma: an analysis of survival in 419 patients. Eur J Gastroenterol Hepatol 1999; 11(3):315–21PubMedCrossRef

19.

Arii S, Yamaoka Y, Futagawa S, et al. Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. The Liver Cancer Study Group of Japan. Hepatology 2000; 32(6):1224–9PubMedCrossRef

20.

Lee HS, Kim KM, Yoon JH, et al. Therapeutic efficacy of transcatheter arterial chemoembolization as compared with hepatic resection in hepatocellular carcinoma patients with compensated liver function in a hepatitis B virus-endemic area: a prospective cohort study. J Clin Oncol 2002; 20(22):4459–65PubMedCrossRef

21.

Hemming AW, Reed AI, Howard RJ, et al. Preoperative portal vein embolization for extended hepatectomy. Ann Surg 2003; 237(5):686–91; discussion 691–3PubMedCrossRef

22.

The Liver Cancer Study Group of Japan. The general rules for the clinical and pathological study of primary liver cancer. Version 4. Tokyo: Kanehara & Co., Ltd., 2000

23.

The Liver Cancer Study Group of Japan. The general rules for the clinical and pathological study of primary liver cancer. Version 2. Tokyo: Kanehara & Co., Ltd., 2003

24.

Vauthey JN, Abdalla EK, Doherty DA, et al. Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 2002; 8(3):233–40PubMedCrossRef

25.

Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000; 92(3):205–16PubMedCrossRef

26.

Nakamura H, Hori S, Kozuka T. Transcatheter treatment of localized hepatocellular carcinoma: segmental arterioportal chemoembolization. Reg Cancer Treat 1992; 5:102–5

27.

Park KW, Park JW, Cho SH, et al. Survival analysis for patients with hepatocellular carcinoma according to stage, liver function and treatment modalities. Korean J Hepatol 2006; 12(1):41–54PubMed

28.

Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 2006; 243(3):364–72PubMedCrossRef

29.

Sugawara Y, Yamamoto J, Higashi H, et al. Preoperative portal embolization in patients with hepatocellular carcinoma. World J Surg 2002; 26(1):105–10PubMedCrossRef

30.

Jaeck D, Bachellier P, Nakano H, et al. One or two-stage hepatectomy combined with portal vein embolization for initially nonresectable colorectal liver metastases. Am J Surg 2003; 185(3):221–9PubMedCrossRef

31.

Liu H, Fu Y. Portal vein embolization before major hepatectomy. World J Gastroenterol 2005; 11(14):2051–4PubMed

32.

Broering DC, Hillert C, Krupski G, et al. Portal vein embolization vs. portal vein ligation for induction of hypertrophy of the future liver remnant. J Gastrointest Surg 2002; 6(6):905–13; discussion 913PubMedCrossRef

33.

Takayasu K, Arii S, Ikai I, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology 2006; 131(2):461–9PubMedCrossRef

34.

Llovet JM, Real MI, Montana X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002; 359(9319):1734–9PubMedCrossRef

35.

Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002; 35(5):1164–71PubMedCrossRef

36.

Hatanaka Y, Yamashita Y, Takahashi M, et al. Unresectable hepatocellular carcinoma: analysis of prognostic factors in transcatheter management. Radiology 1995; 195(3):747–52PubMed

37.

Savastano S, Miotto D, Casarrubea G, Teso S, Chiesura-Corona M, Feltrin GP. Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with Child’s grade A or B cirrhosis: a multivariate analysis of prognostic factors. J Clin Gastroenterol 1999; 28(4):334–40PubMedCrossRef

Title: Preoperative Portal Vein Embolization and Surgical Resection in Patients with Hepatocellular Carcinoma and Small Future Liver Remnant Volume: Comparison with Transarterial Chemoembolization
Authors: Dong Dae Seo, MD
Han Chu Lee, MD
Myoung Kuk Jang, MD
Hyun Ju Min, MD
Kang Mo Kim, MD
Young Suk Lim, MD
Young-Hwa Chung, MD
Yung Sang Lee, MD
Dong Jin Suh, MD
Gi-Young Ko, MD
Young-Joo Lee, MD
Sung-Gyu Lee, MD
Publication date: 01-12-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 12/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-007-9553-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative Portal Vein Embolization and Surgical Resection in Patients with Hepatocellular Carcinoma and Small Future Liver Remnant Volume: Comparison with Transarterial Chemoembolization

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2007

Can We Understand the Clinical Biology of Gastric Cancer and Exploit it? May be, but It is a Challenge!

Impact of Adjuvant Radiation on Survival: A Note of Caution When Using Cancer Registry Data to Evaluate Adjuvant Treatments

Epithelioid Sarcoma: Prognostic Factors and Survival in a Series of Patients Treated at a Single Institution

Sentinel Lymph Node Biopsy in Cutaneous Melanoma: A Case-Control Study

Intrahepatic Lymphatic Invasion Independently Predicts Poor Survival and Recurrences after Hepatectomy in Patients with Colorectal Carcinoma Liver Metastases

Salvage Surgery Following Downstaging of Unresectable Hepatocellular Carcinoma—A Strategy to Increase Resectability