Role of Portal Vein Embolization in Hepatocellular Carcinoma Management and Its Effect on Recurrence: A Case‐control Study

Abstract

BackgroundLiver regeneration that occurs after portal vein embolization (PVE) may have adverse effects on the microscopic tumor foci in the residual liver mass in patients with hepatocellular carcinoma (HCC).MethodsFifty-four HCC patients with inadequate functional residual liver volume were offered PVE during a seven-year period. Among them, 34 (63%) patients underwent curative resection. They were compared with a matched control group (n = 102) who underwent surgery without PVE. Postoperative complications, pattern of recurrence, and survival were compared between groups.ResultsIn the PVE group, a pre-embolization functional residual liver volume of 23% (12–33.5%) improved to 34% (20–54%) (p = 0.005) at the time of surgery. When the two groups were compared, minor (PVE, 24%; control, 29%; p = 0.651) and major (PVE, 18%; control, 15%; p = 0.784) complications were similar. After a follow-up period of 35 months (standard deviation 25 months), extrahepatic recurrences were detected in 10 PVE patients (29%) and 41 control patients (40%) (p = 0.310). Intrahepatic recurrences were seen in 10 (29%) and 47 (46%) cases (p = 0.109) in the PVE and control groups, respectively. In the PVE group, 41% (n = 14) of the recurrences were detected before one year, compared with 42% (n = 43) in the control group (p = 1). Disease-free survival rates at 1, 3, and 5 years were 57, 29, and 26% in the control group and 60, 42, and 42% in the PVE group (log-rank, p = 0.335). On multivariate analysis, PVE was not a factor affecting survival (p = 0.821).ConclusionsPortal vein embolization increases the resectability of initially unresectable HCC due to inadequate functional residual liver volume, and it has no deleterious oncological effect after major resection of HCC.

Indications for portal vein embolization in perihilar cholangiocarcinoma

“…After critical evaluation of the remaining full‐text articles, 59 articles were included. Finally, we excluded 14 articles with insufficient data and included 45 publications in the analysis (Fig. ), which resulted in the consideration of a total of 3033 patients in the study.…”

“…). The PCCA group included 836 cases (perihilar cholangiocarcinoma in 597 patients, gallbladder cancer in 188 patients, and other hepatic tumors in 51 patients) , and the OHT group included 2197 patients (metastatic liver tumor in 1132 patients, hepatocellular carcinoma in 722 patients, and other hepatic tumors in 343 patients) . Mean ages were 64.2 years and 60.2 years in the PCCA and OHT groups, respectively, and the ratio of men to women was 506:330 and 1230:636 (data were not available in 331 cases of OHT), respectively.…”

Portal Vein Embolization versus Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy

“…The reported data concerning the results of PVE and ALPPS are summarized in Table 1 [23-46] and Table 2 [14, 16, 17, 19, 21, 47-69]. …”

Surgical Management of Primary Hepatocellular Carcinoma

“…In general, PVE is a relatively safe procedure, and it may increase the resectability of initial unresectable HCC and reduce the risk of post hepatectomy liver failure. Additionally, it seems no adverse effect on the oncologic outcome of HCC patients undergoing major liver resection [47,48]. However, the potential for progression of the primary tumor after PVE remains a major concern, whereas a combination of TACE as a complementary procedure to PVE could be considered in order to improve the outcome of HCC patients [49].…”