Portal vein embolization and its effect on tumour progression for colorectal cancer liver metastases

Simoneau, Ève; Hassanain, Mazen; Shaheen, Monte; Aljiffry, Murad; Molla, Nouran; Chaudhury, Prosanto; Anil, Sukumaran; Khashper, Alla; Valenti, David; Metrakos, Peter

doi:10.1002/bjs.9872

Cited by 51 publications

(30 citation statements)

References 39 publications

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“…Moreover, a study by Simoneau et al showed no difference regarding OS even upon tumor progression after PVE. However, patients with tumor progression had significantly shorter DFS [23]. Recently, a systematic review and meta-analysis by Giglio and coworkers concluded that PVE has no negative impact on hepatic recurrence and OS [32].…”

Section: Discussionmentioning

confidence: 99%

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) does not affect proliferation, apoptosis, or angiogenesis as compared to standard liver resection for colorectal liver metastases

et al. 2017

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BackgroundALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a novel two-stage strategy to induce rapid hypertrophy of the future liver remnant (FLR) when patients are in danger of postoperative liver failure due to insufficient FLR. However, the effects of ALPPS on colorectal liver metastases (CRLM) are not clear so far. The aim of our study was to determine whether ALPPS induces proliferation, apoptosis, or vascularization compared to standard (one-stage) liver resection.MethodsSix patients who underwent ALPPS were matched with 12 patients undergoing standard liver resection regarding characteristics of the metastases (size, number), time of appearance (syn-/metachronous), preoperative chemotherapy, primary tumor (localization, TNM stage, grading), and patient variables (gender, age). The largest resected metastasis was used for the analyses. Tissue was stained for tumor cell proliferation (Ki67), apoptosis (TUNEL, caspase-3), vascularization (CD31), and pericytes (αSMA).ResultsVascularization (CD31; p = 0.149), proliferation (Mib-1; p = 0.244), and αSMA expression (p = 0.205) did not significantly differ between the two groups, although a trend towards less proliferation and αSMA expression was observed in patients undergoing ALPPS. Concerning apoptosis, caspase-3 staining showed significantly fewer apoptotic cells upon ALPPS (p < 0.0001), but this was not confirmed by TUNEL staining (p = 0.7344).ConclusionsALPPS does not induce proliferation, apoptosis, or vascularization of CRLM when compared to standard liver resection.

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Section: Discussionmentioning

confidence: 99%

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) does not affect proliferation, apoptosis, or angiogenesis as compared to standard liver resection for colorectal liver metastases

et al. 2017

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“…Indeed, after PVE/PVL alone or in combination in the setting of TSH – with the latter having an even better chance to detect and remove small tumor deposits and metastases during step 1 – up to 24–41% of patients do not undergo stage 2 hepatectomy, mainly due to disease progression [12, 13, 16]. In an analysis by Narita of 80 intended and 61 performed TSH (dropout rate 24%), more than 2 CRLM detected in the FLR during step one were a negative predictor of not achieving the second step [16].…”

mentioning

confidence: 99%

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Lang¹,

Baumgart²,

Mittler³

2018

Dig Surg

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Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has expanded the surgical armamentarium for patients with advanced and bilateral colorectal liver metastases. However, the enthusiasm that the medical fraternity had about ALPPS was hampered by a high mortality rate and early and frequent tumor recurrence. While surgical safety has improved, mainly due to technical refinements and a better patient selection, the oncological value in the face of early tumor recurrence remains unclear. The only randomized controlled trial on ALPPS versus two-stage hepatectomy (TSH) so far confirmed that ALPPS led to higher resectability with comparable perioperative complication rate, but oncological outcome was not measured. Robust data regarding long-term outcome are still missing. TSH and ALPPS might be complementary strategies for the resection of colorectal liver metatsases (CRLM) with ALPPS being reserved for patients with no other surgical option, that is, after failed portal vein embolization or those with an extremely small future liver remnant. In other words, ALPPS can be considered a supplementary tool and a last resort in the liver surgeon’s hand to offer resectability in otherwise nonresectable CRLM. In these individual cases, and always embedded into a multimodal treatment setting, ALPPS may offer a chance of complete tumor removal and prolonged survival and even a chance for cure.

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“…One of the concerns about preoperative PVE is that stimulation of liver hypertrophy can also accelerate tumor growth in the embolized and non‐embolized liver lobe . Portal flow reduction in the embolized liver leads to an increase of arterial blood flow and, subsequently, growth of tumors including micrometastases could be induced, because liver tumors are mostly supplied by arterial blood.…”

Section: Specific Techniques To Increase Resectabilitymentioning

confidence: 99%

“…The details are described in the next section. From the viewpoint that liver hypertrophy after PVL/PVE may accelerate tumor growth, the left‐first approach has now become a mainstream strategy of TSH.…”

Section: Specific Techniques To Increase Resectabilitymentioning

confidence: 99%

How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective

Imai

Adam

Baba

2019

Annals of Gastroent Surgery

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Although surgical resection is the only treatment of choice that can offer prolonged survival and a chance of cure in patients with colorectal liver metastases (CRLM), nearly 80% of patients are deemed to be unresectable at the time of diagnosis. Considerable efforts have been made to overcome this initial unresectability, including expanding the indication of surgery, the advent of conversion chemotherapy, and development and modification of specific surgical techniques, regulated under multidisciplinary approaches. In terms of specific surgical techniques, portal vein ligation/embolization can increase the volume of future liver remnant and thereby reduce the risk of hepatic insufficiency and death after major hepatectomy. For multiple bilobar CRLM that were traditionally considered unresectable even with preoperative chemotherapy and portal vein embolization, two‐stage hepatectomy was introduced and has been adopted worldwide with acceptable short‐ and long‐term outcomes. Recently, ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was reported as a novel variant of two‐stage hepatectomy. Although issues regarding safety remain unresolved, rapid future liver remnant hypertrophy and subsequent shorter intervals between the two stages lead to a higher feasibility rate, reaching 98%. In addition, adding radiofrequency ablation and vascular resection and reconstruction techniques can allow expansion of the pool of patients with CRLM who are candidates for liver resection and thus a cure. In this review, we discuss specific techniques that may expand the criteria for resectability in patients with initially unresectable CRLM.

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Portal vein embolization and its effect on tumour progression for colorectal cancer liver metastases

Cited by 51 publications

References 39 publications

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) does not affect proliferation, apoptosis, or angiogenesis as compared to standard liver resection for colorectal liver metastases

ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) does not affect proliferation, apoptosis, or angiogenesis as compared to standard liver resection for colorectal liver metastases

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective

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