Portal vein embolisation prior to hepatic resection for colorectal liver metastases and the effects of periprocedure chemotherapy

Beal, Isobel; Anthony, SP; Papadopoulou, Anthie; Hutchins, Robert; Fusai, Giuseppe; Rh, Begent; Davies, N.; Tibballs, Jonathan; Davidson, Brian R

doi:10.1259/bjr/29855825

Cited by 80 publications

(65 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Since the inhibitory effect of chemotherapy on the hypertrophy response appears to be less than previously assumed, there seems to be a place for chemotherapy after PVE to control tumor growth in patients with colorectal metastases, particularly in those who previously have shown to be good responders. 60,61 Systemic chemotherapy may also have the advantage of controlling the progression of extrahepatic disease in the waiting time until resection. This is an area for controlled studies to further determine the role of chemotherapy after PVE.…”

Section: Discussionmentioning

confidence: 99%

“…Beal et al reported in a retrospective study including 15 patients, of which 10 received post-PVE chemotherapy, that hypertrophy of the FRL did occur in the post-PVE chemotherapy group, although significantly less compared with the nonchemotherapy group. 60 Tumor progression was seen in four of the five patients without post-PVE chemotherapy, whereas tumor reduction was seen in six of the ten patients with chemotherapy.…”

Section: Post-pve Chemotherapymentioning

confidence: 93%

“…If preoperative PVE is required, chemotherapy is discontinued several weeks prior to embolization until surgery 3-4 weeks thereafter, because of its alleged negative influence on the hypertrophy response. 11,60,61 This allows tumor progression to occur in the period in which chemotherapy is discontinued in addition to the possible tumor stimulating effects of PVE. Beal et al reported in a retrospective study including 15 patients, of which 10 received post-PVE chemotherapy, that hypertrophy of the FRL did occur in the post-PVE chemotherapy group, although significantly less compared with the nonchemotherapy group.…”

Section: Post-pve Chemotherapymentioning

confidence: 99%

See 2 more Smart Citations

Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?

et al. 2008

View full text Add to dashboard Cite

Although preoperative portal vein embolization (PVE) is an effective means to increase future remnant liver (FRL) volume, little has been published on possible adverse effects. This review discusses the clinical and experimental evidence regarding the effect of PVE on tumor growth in both embolized and nonembolized liver lobes, as well as potential strategies to control tumor progression after PVE. A literature review was performed using MEDLINE with keywords related to experimental and clinical studies concerning PVE, portal vein ligation (PVL), and tumor growth. Cross-references and references from reviews were also checked. Clinical and experimental data suggest that tumor progression can occur after preoperative PVE in embolized and nonembolized liver segments. Clinical evidence indicating possible tumor progression in patients with colorectal metastases or with primary liver tumors is based on studies with small sample size. Although multiple studies demonstrated tumor progression, evidence concerning a direct increase in tumor growth rate as a result of PVE is circumstantial. Three possible mechanisms influencing tumor growth after PVE can be recognized, namely changes in cytokines or growth factors, alteration in hepatic blood supply and an enhanced cellular host response promoting local tumor growth after PVE. Post-PVE chemotherapy and sequential transcatheter arterial chemoembolization (TACE) before PVE have been proposed to reduce tumor mass after PVE. We conclude that tumor progression can occur after PVE in patients with colorectal metastases as well as in patients with primary liver tumors. However, further research is needed in order to rate this risk of tumor progression after PVE.Preoperative portal vein embolization (PVE) is an accepted intervention in patients requiring major liver resection in whom the estimated future remnant liver (FRL) is too small to allow safe resection.1,2 PVE induces atrophy of the embolized, tumor-bearing liver lobe while compensatory hypertrophy of the nonembolized lobe occurs, thereby increasing FRL volume and function.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Post-pve Chemotherapymentioning

confidence: 93%

Section: Post-pve Chemotherapymentioning

confidence: 99%

See 1 more Smart Citation

Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?

et al. 2008

View full text Add to dashboard Cite

show abstract

“…PVE may have limited application in patients with ipsilateral portal vein thrombus (PVT) or clinically evident portal hypertension (9). There is controversy regarding the appropriate utilization of chemotherapy and PVE with studies suggesting tumor progression following suspension of systemic chemotherapy (17)(18)(19)(20) and decreased FLR hypertrophy in patients on concurrent chemotherapy (21).…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation

Shah

Zendejas-Ruiz

Thornton

et al. 2017

J. Gastrointest. Oncol.

View full text Add to dashboard Cite

Colorectal cancer patients have a high incidence of liver metastasis (ml-CRC). Surgical resection is the gold standard for treatment of hepatic metastasis but only a small percent of patients are traditional candidates based on disease extent and adequate size of the future liver remnant (FLR). Interventions such as portal vein embolization (PVE) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are performed to increase FLR for operative conversion. Limitations to PVE include intrahepatic disease progression, portal vascular invasion, and utilization with concurrent chemotherapy. ALPPS is associated with a high morbidly and mortality. Radiation lobectomy (RL) with yttrium-90 (Y-90) delivers transarterial ablative brachytherapy to the future hepatectomy site which generates FLR hypertrophy similar or greater than PVE. Early results indicate that RL is safe, effective, and may offer unique benefits by providing cytoreduction of hepatic metastases which extends FLR hypertrophy time and allows FLR surveillance to gauge disease biology. A retrospective analysis of four patients with ml-CRC treated with RL prior to hepatectomy was performed to evaluate initial safety, efficacy, FLR hypertrophy, and radiopathologic correlation. Adverse events after RL and hepatectomy were evaluated. Imaging findings were analyzed for efficacy defined as FLR hypertrophy and disease control. Radiopathologic correlation was performed after histologic analysis. RL was well tolerated without major adverse events or hepatic decompensation. FLR hypertrophy ranged from 24.9% to 119% at mean follow-up of three months. The majority of complications were related to surgical instrumentation of the FLR due to upstaging at time of surgery. Hepatectomy specimen histology demonstrated complete pathologic response in 50% of patients, 50% radiopathologic concordance rate, and no significant hepatic fibrosis. Initial experience with neoadjuvant RL for ml-CRC is safe and provides both durable disease control and FLR hypertrophy with concurrent chemotherapy. A 50% complete pathologic response rate raises the possibility of definitive chemoradiation in poor surgical candidates. Prospective investigation is required.

show abstract

“…If preoperative portal vein occlusion is required, neoadjuvant chemotherapy is also frequently used to minimize the risk of tumour progression during the time interval between occlusion and resection. Previous clinical studies have shown no or only modest impact by neoadjuvant chemotherapy on liver regeneration after portal vein occlusion [3,11,12]. On the other hand, M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 adjuvant chemotherapy has been shown to cause suppression and delay of regeneration after partial hepatectomy in rats [13].…”

Section: Introductionmentioning

confidence: 99%

Prolonged chemotherapy impairs liver regeneration after portal vein occlusion – An audit of 26 patients

Sturesson¹,

Keussen²,

Tranberg³

2010

European Journal of Surgical Oncology (EJSO)

View full text Add to dashboard Cite

Aim: The aim of the present retrospective study was to investigate the influence of neoadjuvant chemotherapy on liver regeneration after portal vein occlusion before major hepatectomy. Results: After portal vein occlusion, the ratio of the future liver remnant volume to total parenchymal liver volume (FLR%) was reduced in patients receiving neoadjuvant chemotherapy (27 ± 1 % vs 32 ± 1 %, p=0.03). A smaller future liver remnant before portal vein occlusion resulted in a greater degree of hypertrophy (r 2 =0.18, p=0.04). Patients with tumour size greater than 60 mm showed a decreased degree of hypertrophy (7 ± 1) % as compared to patients with smaller tumours (13 ± 1 %, p=0.01). There was one death shortly after portal vein embolisation. 19/26 patients were resected with zero operative mortality. Method Conclusion:Prolonged neoadjuvant chemotherapy has a small negative effect on liver regeneration induced by portal vein occlusion. Liver regeneration induced by portal vein occlusion is relatively large when tumour burden is small.

show abstract

Portal vein embolisation prior to hepatic resection for colorectal liver metastases and the effects of periprocedure chemotherapy

Cited by 80 publications

References 19 publications

Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?

Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?

Neoadjuvant transarterial radiation lobectomy for colorectal hepatic metastases: a small cohort analysis on safety, efficacy, and radiopathologic correlation

Prolonged chemotherapy impairs liver regeneration after portal vein occlusion – An audit of 26 patients

Contact Info

Product

Resources

About