Long-Term Survival and Disease Recurrence Following Portal Vein Embolisation Prior to Major Hepatectomy for Colorectal Metastases

Pamecha, Viniyendra; Glantzounis, Georgios K.; Davies, N.; Fusai, Giuseppe; Sharma, Dinesh; Davidson, Brian R

doi:10.1245/s10434-008-0269-4

Cited by 69 publications

(70 citation statements)

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“…The resection rate after PVE is 60 -70%, mainly limited by disease progression (Mueller et al, 2008;Pamecha et al, 2009). This may reflect either a rapid disease progression in patients who are selected for PVE or that PVE stimulates tumour growth.…”

mentioning

confidence: 99%

“…Tumour growth exceeding that of the normal liver parenchyma has been shown on imaging following PVE in patients with contra lateral lobe metastases (Elias et al, 1999), and the tumour-doubling time following PVE has been shown to be reduced from 92 to 76 days (Kokudo et al, 2001). There have been concerns that PVE may increase the risk of disease recurrence after curative resection (Kokudo et al, 2001;Pamecha et al, 2009). The influence of PVE on tumour growth characteristics on resected cancers has not been investigated.…”

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confidence: 99%

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Effect of portal vein embolisation on the growth rate of colorectal liver metastases

et al. 2009

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Portal vein embolisation (PVE) is used to increase the remnant liver volume before major liver resection for colorectal metastases. The resection rate after PVE is 60 -70%, mainly limited by disease progression. The effect of PVE on tumour growth rate has not been investigated. The objective of this study was to compare the growth characteristics of resected colorectal liver metastases in patients undergoing pre-operative PVE with those of matched controls who had not undergone PVE. There were 22 patients who had undergone preoperative PVE and 20 matched controls. Tumour growth rate was calculated by the change in tumour volume (CT/MRI volumetric assessment) from diagnosis to resection. Resected histological specimens were examined by two histopathologists independently for cell differentiation, percentage tumour cell necrosis and mitotic rate. Immunochemical staining with Ki67 was carried out using the MIB-1 monoclonal antibody and quantified using a Glasgow cell-counting graticule. The groups were comparable in demographics, stage of primary disease, volume of liver metastases at presentation and chemotherapy received. The tumour growth rate calculated from imaging was more rapid in the PVE group compared with that in controls (control: 0.05 ± 0.25 ml day À1 , PVE: 0.36 ± 0.68 ml day À1 , P ¼ 0.06). Histology showed no difference in the degree of differentiation, extent of necrosis or apoptosis between the two groups. However, mitotic rate was higher post PVE, as was the proliferation index Ki67 (P ¼ 0.04). This study has confirmed that tumour growth rate increased following PVE and that this is related to increased tumour cell division.

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confidence: 99%

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Effect of portal vein embolisation on the growth rate of colorectal liver metastases

et al. 2009

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“…5,8-11 In these studies the evidence of direct stimulation of tumor growth by PVE is circumstantial, and the rate of unresectability after PVE due to intrahepatic and/or extrahepatic tumor progression is regularly around 25%, which is not very different from the results of Pamecha et al 6 The main problem raised by this article is the indication of PVO and its association with chemotherapy before a major liver resection. The indication of PVO should depend on several factors including the extent and expected difficulties of resection, the status of nontumorous liver parenchyma, and the exact quantification of sufficient minimal functional hepatic volume.…”

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confidence: 76%

Portal Vein Occlusion Prior to Extensive Resection in Colorectal Liver Metastasis: A Necessity Rather than an Option!

Belghiti

Benhaïm

2009

Ann Surg Oncol

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Preoperative portal vein occlusion (PVO) of one liver lobe is regularly used for inducing liver hypertrophy of the contralateral lobe to prevent postoperative liver failure in patients with an anticipated insufficient future liver remnant (FLR) following resection.1 A similar rate of hypertrophy of the liver parenchyma with preserved portal flow can be obtained either by percutaneous portal embolization using several agents or by portal vein ligation. This strategy of preoperatively manipulating the liver volume has been acclaimed as a major step in liver surgery, paving the way for extensive resection for initially unresectable tumors. 3It has been clearly shown that chemotherapy of colorectal liver metastases (CRLM) can provide significant downstaging of liver disease enabling curative rescue resection and translating into an improved long-term survival.3 Over the last decade, both PVO and chemotherapy have dramatically widened the scope of surgical resection of CRLM. Several institutions involved in the surgical treatment of CRLM have claimed that preoperative PVO has increased the number of candidates for complete tumor resection.3-5 The hypertrophy of the FLR allows the safety of major resection.In the present issue, the article by Pamecha et al. tends to dampen the early enthusiasm regarding PVO for CLRM.6 This well-written article, which compares the surgical outcomes of two groups of patients operated for CRLM with or without portal vein embolization (PVE), highlights the unfavorable effects of PVE. Firstly, one-third of the patients were nonoperable after PVE because of rapid progression of disease, and secondly the long-term survival for patients resected after PVE was less favorable than for the group who underwent immediate surgery.A legitimate concern is whether the stimulus for liver regeneration induced by PVO might enhance tumor growth. As reported in a recent review of this journal, experimental studies have shown that hepatectomy or portal ligation in rats induced tumor growth and in some clinical studies, after PVO, the growth rate of liver metastasis seems to be more rapid than that of the liver parenchyma including a higher proliferative activity of intrahepatic metastasis possibly induced by hyper arterializations. 7Although these studies clearly demonstrate that tumor progression after PVO is possible, we believe that it is not yet time to consider a restriction of preoperative modulation of the liver parenchyma by PVO. Percutaneous embolization is a safe procedure that could reduce intrahepatic recurrence rate after right hepatectomy for unilobar CRLM.8 Several series have shown that in patients with extensive CRLM who would otherwise be unresectable, PVO followed by surgery offers a significant benefit with a 5-year survival up to 40%. 5,8-11 In these studies the evidence of direct stimulation of tumor growth by PVE is circumstantial, and the rate of unresectability after PVE due to intrahepatic and/or extrahepatic tumor progression is regularly around 25%, which is not very different ...

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“…Again there was a tendency to higher morbidity in the PVE group (36% vs. 20%) but in a similar manner to the study of Wicherts et al more of these patients had undergone a right trisectionectomy (22% vs. 11%). [85] The most important finding in both of these series is that nearly a third of all patients selected to undergo pre-operative portal vein embolisation do not undergo subsequent surgery and this is primarily a consequence of disease progression. [84,85] It is likely that the most important factor driving this disease progression is the compensatory increase in arterial blood flow which occurs in the embolised lobe.…”

Section: Pre-operative Portal Vein Embolisationmentioning

confidence: 96%

“…[85] The most important finding in both of these series is that nearly a third of all patients selected to undergo pre-operative portal vein embolisation do not undergo subsequent surgery and this is primarily a consequence of disease progression. [84,85] It is likely that the most important factor driving this disease progression is the compensatory increase in arterial blood flow which occurs in the embolised lobe. [86] The blood supply of colorectal metastases is predominantly derived from the hepatic artery [87] and it is probable that the increase in arterial flow results in increased oxygen and nutrient supply to the tumour.…”

Section: Pre-operative Portal Vein Embolisationmentioning

confidence: 96%

The Assessment and Management of Chemotherapy Associated Liver Injury

Robinson¹,

Scott²,

Manas³

et al. 2013

Hepatic Surgery

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Long-Term Survival and Disease Recurrence Following Portal Vein Embolisation Prior to Major Hepatectomy for Colorectal Metastases

Abstract: 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.

Cited by 69 publications

References 25 publications

Effect of portal vein embolisation on the growth rate of colorectal liver metastases

Effect of portal vein embolisation on the growth rate of colorectal liver metastases

Portal Vein Occlusion Prior to Extensive Resection in Colorectal Liver Metastasis: A Necessity Rather than an Option!

The Assessment and Management of Chemotherapy Associated Liver Injury

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