Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2016

01-10-2016 | Hepatobiliary Tumors

Oncological Outcomes of Major Liver Resection Following Portal Vein Embolization: A Systematic Review and Meta-analysis

Authors: Mariano Cesare Giglio, MD, Alexandros Giakoustidis, PhD, Ahmed Draz, MD, Zaynab A. R. Jawad, MSc, MRCS, Madhava Pai, MSc, FRCS, Nagy A. Habib, ChM, FRCS, Paul Tait, MA, FRCR, Adam E. Frampton, PhD, MRCS, Long R. Jiao, MD, FRCS

Published in: Annals of Surgical Oncology | Issue 11/2016

Login to get access

Abstract

Background

Preoperative portal vein occlusion with either percutaneous portal vein embolization (PVE) or portal vein ligation is routinely used to induce liver hypertrophy prior to major liver resection in patients with hepatic malignancy. While this increases the future liver remnant, and hence the number of patients suitable for resection, recent evidence suggests that induction of liver hypertrophy preoperatively may promote tumor growth and increase recurrence rates. The aims of this current study were to evaluate the impact of PVE on hepatic recurrence rate and survival in patients with colorectal liver metastases (CRLM).

Methods

The MEDLINE, EMBASE and Web of Science databases were searched to identify studies assessing the oncological outcomes of patients undergoing major liver resection for CRLM following PVE. Studies comparing patients undergoing one-stage liver resection with or without preoperative PVE were included. The primary outcome was postoperative hepatic recurrence (PHR), while secondary outcomes were 3- and 5-year overall survival (OS).

Results

Of the 2131 studies identified, six non-randomized studies (n = 668) met the eligibility criteria, comparing outcomes of patients undergoing major liver resection with or without PVE (n = 182 and n = 486, respectively). No significant difference was observed in PHR (odds ratio [OR] 0.78; 95 % confidence interval [CI] 0.42–1.44), 3-year OS (OR 0.80; 95 % CI 0.56–1.14) or 5-year OS (OR 1.12; 95 % CI 0.40–3.11).

Conclusions

PVE does not have any adverse effect on PHR or OS in patients undergoing major liver resection for CRLM. Further studies based on individual patient data are needed to provide definitive answers.
Appendix
Available only for authorised users
Literature
1.
Rees M, Tekkis PP, Welsh FKS, O’Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247(1):125–35.CrossRefPubMed
2.
Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235(6):759–66.CrossRefPubMedPubMedCentral
3.
Capussotti L, Muratore A, Mulas MM, Massucco P, Aglietta M. Neoadjuvant chemotherapy and resection for initially irresectable colorectal liver metastases. Br J Surg. 2006;93(8):1001–6.CrossRefPubMed
4.
Jaeck D, Bachellier P, Guiguet M, et al. Long-term survival following resection of colorectal hepatic metastases. Association Française de Chirurgie. Br J Surg. 1997;84(7):977–80.CrossRefPubMed
5.
Abdalla EK, Adam R, Bilchik AJ, Jaeck D, Vauthey J-N, Mahvi D. Improving resectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol. 2006;13(10):1271–80.CrossRefPubMed
6.
Schindl MJ, Redhead DN, Fearon KCH, Garden OJ, Wigmore SJ. The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut. 2005;54(2):289–96.CrossRefPubMedPubMedCentral
7.
Khatri VP, Petrelli NJ, Belghiti J. Extending the frontiers of surgical therapy for hepatic colorectal metastases: is there a limit? J Clin Oncol. 2005;23(33):8490–9.CrossRefPubMed
8.
Mueller L, Hillert C, Möller L, Krupski-Berdien G, Rogiers X, Broering DC. Major hepatectomy for colorectal metastases: is preoperative portal occlusion an oncological risk factor? Ann Surg Oncol. 2008;15(7):1908–17.CrossRefPubMed
9.
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):803–8.CrossRefPubMed
10.
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):521–7.PubMed
11.
Azoulay D, Castaing D, Smail A, et al. Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg. 2000;231(4):480–6.CrossRefPubMedPubMedCentral
12.
Abulkhir A, Limongelli P, Healey AJ, et al. Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg. 2008;247(1):49–57.CrossRefPubMed
13.
Barbaro B, Di Stasi C, Nuzzo G, Vellone M, Giuliante F, Marano P. Preoperative right portal vein embolization in patients with metastatic liver disease. Metastatic liver volumes after RPVE. Acta Radiol. 2003;44(1):98–102.PubMed
14.
Kokudo N, Tada K, Seki M, et al. Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology. 2001;34(2):267–72.CrossRefPubMed
15.
Elias D, De Baere T, Roche A, Mducreux, Leclere J, Lasser P. During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma. Br J Surg. 1999;86(6):784–8.CrossRefPubMed
16.
Wicherts DA, de Haas RJ, Andreani P, et al. Impact of portal vein embolization on long-term survival of patients with primarily unresectable colorectal liver metastases. Br J Surg. 2010;97(2):240–50.CrossRefPubMed
17.
Alvarez FA, Ardiles V, de Santibañes M, Pekolj J, de Santibañes E. Associating liver partition and portal vein ligation for staged hepatectomy offers high oncological feasibility with adequate patient safety: a prospective study at a single center. Ann Surg. 2015;261(4):723–32.CrossRefPubMed
18.
Gall TMH, Sodergren MH, Frampton AE, et al. Radio-frequency-assisted liver partition with portal vein ligation (RALPP) for liver regeneration. Ann Surg. 2015;261(2):e45–6.CrossRefPubMed
19.
Robles R, Parrilla P, López-Conesa A, et al. Tourniquet modification of the associating liver partition and portal ligation for staged hepatectomy procedure. Br J Surg. 2014;101(9):1129–34; discussion 1134.CrossRefPubMed
20.
Tierney JF, Stewart L, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8:16.CrossRefPubMedPubMedCentral
21.
Oussoultzoglou E, Bachellier P, Rosso E, et al. Right portal vein embolization before right hepatectomy for unilobar colorectal liver metastases reduces the intrahepatic recurrence rate. Ann Surg. 2006;244(1):71–9.CrossRefPubMedPubMedCentral
22.
23.
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230(3):309–18; discussion 318–321.CrossRefPubMedPubMedCentral
24.
25.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. JAMA. 2000;283(15):2008–12.CrossRefPubMed
26.
Pamecha V, Glantzounis G, Davies N, Fusai G, Sharma D, Davidson B. Long-term survival and disease recurrence following portal vein embolisation prior to major hepatectomy for colorectal metastases. Ann Surg Oncol. 2009;16(5):1202–07.CrossRefPubMed
27.
Ardito F, Vellone M, Barbaro B, et al. Right and extended-right hepatectomies for unilobar colorectal metastases: impact of portal vein embolization on long-term outcome and liver recurrence. Surgery. 2013;153(6):801–10.CrossRefPubMed
28.
Pamecha V, Levene A, Grillo F, Woodward N, Dhillon A, Davidson BR. Effect of portal vein embolisation on the growth rate of colorectal liver metastases. Br J Cancer. 2009;100(4):617–22.CrossRefPubMedPubMedCentral
29.
Hoekstra LT, van Lienden KP, Doets A, Busch ORC, Gouma DJ, van Gulik TM. Tumor progression after preoperative portal vein embolization. Ann Surg. 2012;256(5):812–7; discussion 817–818.CrossRefPubMed
30.
Denys AL, Abehsera M, Leloutre B, et al. Intrahepatic hemodynamic changes following portal vein embolization: a prospective Doppler study. Eur Radiol. 2000;10(11):1703–7.CrossRefPubMed
31.
Nagino M, Nimura Y, Kamiya J, Kanai M, Hayakawa N, Yamamoto H. Immediate increase in arterial blood flow in embolized hepatic segments after portal vein embolization: CT demonstration. Am J Roentgenol. 1998;171(4):1037–9.CrossRefPubMed
32.
33.
Christophi C, Harun N, Fifis T. Liver regeneration and tumor stimulation—a review of cytokine and angiogenic factors. J Gastrointest Surg. 2008;12(5):966–80.CrossRefPubMed
34.
Shindoh J, Tzeng C-WD, Aloia TA, et al. Portal vein embolization improves rate of resection of extensive colorectal liver metastases without worsening survival. Br J Surg. 2013;100(13):1777–83.CrossRefPubMed
35.
Yamashita S, Hasegawa K, Takahashi M, et al. One-stage hepatectomy following portal vein embolization for colorectal liver metastasis. World J Surg. 2013;37(3):622–8.CrossRefPubMed
36.
Tanaka K, Shimada H, Ueda M, Matsuo K, Endo I, Togo S. Long-term characteristics of 5-year survivors after liver resection for colorectal metastases. Ann Surg Oncol. 2007;14(4):1336–46.CrossRefPubMed
37.
Nikfarjam M, Shereef S, Kimchi ET, et al. Survival outcomes of patients with colorectal liver metastases following hepatic resection or ablation in the era of effective chemotherapy. Ann Surg Oncol. 2009;16(7):1860–7.CrossRefPubMed
38.
Abdalla E, Barnett C. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg. 2002;100(13):1777–83.
39.
Wang Z-M, Chen Y-Y, Chen F-F, Wang S-Y, Xiong B. Peri-operative chemotherapy for patients with resectable colorectal hepatic metastasis: a meta-analysis. Eur J Surg Oncol. 2015;41(9):1197–203.CrossRefPubMed
40.
Ciliberto D, Prati U, Roveda L, et al. Role of systemic chemotherapy in the management of resected or resectable colorectal liver metastases: a systematic review and meta-analysis of randomized controlled trials. Oncol Rep. 2012;27(6):1849–56.PubMed
41.
Adam R, De Gramont A, Figueras J, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist. 2012;17(10):1225–39.CrossRefPubMedPubMedCentral
42.
Pommier R, Ronot M, Cauchy F, et al. Colorectal liver metastases growth in the embolized and non-embolized liver after portal vein embolization: influence of initial response to induction chemotherapy. Ann Surg Oncol. 2014;21(9):3077–83.CrossRefPubMed
43.
Adam R, Pascal G, Castaing D, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240(6):1052–61; discussion 1061–1064.CrossRefPubMedPubMedCentral
44.
Neumann UP, Thelen A, Röcken C, et al. Nonresponse to pre-operative chemotherapy does not preclude long-term survival after liver resection in patients with colorectal liver metastases. Surgery. 2009;146(1):52–9.CrossRefPubMed
45.
Valentine JC, Pigott TD, Rothstein HR. How many studies do you need? A primer on statistical power for meta-analysis. J Educ Behav Stat. 2010;35(2):215–47.CrossRef
Metadata
Title
Oncological Outcomes of Major Liver Resection Following Portal Vein Embolization: A Systematic Review and Meta-analysis
Authors
Mariano Cesare Giglio, MD
Alexandros Giakoustidis, PhD
Ahmed Draz, MD
Zaynab A. R. Jawad, MSc, MRCS
Madhava Pai, MSc, FRCS
Nagy A. Habib, ChM, FRCS
Paul Tait, MA, FRCR
Adam E. Frampton, PhD, MRCS
Long R. Jiao, MD, FRCS
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 11/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5264-6

Other articles of this Issue 11/2016

Annals of Surgical Oncology 11/2016 Go to the issue

Breast Oncology

How Often Is Treatment Effect Identified in Axillary Nodes with a Pathologic Complete Response After Neoadjuvant Chemotherapy?

Hepatobiliary Tumors

Prognostic Implication of KRAS Status after Hepatectomy for Colorectal Liver Metastases Varies According to Primary Colorectal Tumor Location

Thoracic Oncology

Impact of Neoadjuvant Chemoradiation on Short-Term Outcomes for Esophageal Squamous Cell Carcinoma Patients: A Meta-analysis

Melanomas

National Evaluation of Hospital Performance on the New Commission on Cancer Melanoma Quality Measures

Reconstructive Oncology

Feasibility and Outcomes of the Third or More Episodes of Sequential Microvascular Reconstruction for Recurrent or Second Primary Oral Cancer

Breast Oncology

How Beneficial is Follow-Up Mammography in Elderly Breast Cancer Survivors?