Segment 2/3 Hypertrophy is Greater When Right Portal Vein Embolisation is Extended to Segment 4 in Patients with Colorectal Liver Metastases: A Retrospective Cohort Study

Abstract

Background In patients with colorectal cancer liver metastases (CRLM), right portal vein embolisation (RPVE) is used to increase the volume of the future remnant liver (FRL) before major hepatic resection. It is not established whether embolisation of segment 4 in addition RPVE (RPVE + 4) induces greater hypertrophy of the FRL. Limitations of prior studies include heterogenous populations and use of hypertrophy metrics sensitive to baseline variables. Methods From 2010 to 2015, consecutive patients undergoing RPVE or RPVE + 4 for CRLM, who had not undergone prior major hepatic resection and in whom imaging was available, were included in a retrospective study. Data were extracted from hospital electronic records. Volumetric assessments of segments 2–3 were made on cross-sectional imaging before and after embolisation and corrected for standardised liver volume. Results Ninety-nine patients underwent PVE, and 60 met the inclusion criteria. Thirty-eight patients underwent RPVE, and 22 underwent RPVE + 4. Forty-five patients had undergone median 6 cycles of prior chemotherapy. Eighteen patients had FRL metastases at PVE, and 16 had undergone subsegmental metastasectomy in the FRL. Assessments of the degree of hypertrophy (DH) of segments 2/3 were made at median 35 (interquartile range 30–49) days after PVE. RPVE + 4 resulted in a significantly greater increase in DH than RPVE (7.7 ± 1.8% vs 11.3 ± 2.6%, p = 0.011). No confounding association between baseline variables and the decision to undertake RPVE or RPVE + 4 was identified. Median survival was 2.4 years and was not influenced by segment 4 embolisation. Conclusion RPVE + 4 results in greater DH of segments 2/3 than RPVE in people with CLRM.

Portal vein embolization with n-butyl-cyanoacrylate before hepatectomy: a single-center retrospective analysis of 46 consecutive patients

“…The mean DH of 9.7% (16,17,20,22,28) and KGR of 2.1%/week (16,20,28,29) in the present study is consistent with previous studies. No correlation was observed between DH and mortality in the present study, even though others have seen correlations with DH and post-hepatectomy outcomes (20).…”

“…Of the patients, 91% had enough FLR hypertrophy to undergo the planned liver surgery, consistent with previous reports (4,6,(16)(17)(18) and guidelines (19). Three patients (7%) did not undergo liver surgery due to tumor progress on follow-up CT and surgery was aborted in another 5 (12%) patients due to perioperatively discovered tumor progress, consistent with previous studies (4,6,16,17). The frequency of liver failures (7%) in the present study is consistent with other reports (4%-10%) (16,17,20,21), and so is the frequency of major postoperative complications (4,6,16,22).…”

“…Three patients (7%) did not undergo liver surgery due to tumor progress on follow-up CT and surgery was aborted in another 5 (12%) patients due to perioperatively discovered tumor progress, consistent with previous studies (4,6,16,17). The frequency of liver failures (7%) in the present study is consistent with other reports (4%-10%) (16,17,20,21), and so is the frequency of major postoperative complications (4,6,16,22). Of the adverse events after PVE, the minor complications were expected side effects (19).…”

“…Of the patients, 91% had enough FLR hypertrophy to undergo the planned liver surgery, consistent with previous reports (4,6,16–18) and guidelines (19). Three patients (7%) did not undergo liver surgery due to tumor progress on follow-up CT and surgery was aborted in another 5 (12%) patients due to perioperatively discovered tumor progress, consistent with previous studies (4,6,16,17).…”

Current role of trisectionectomy for hepatopancreatobiliary malignancies

“…This measurement indirectly displays the extent and quality of the surgery itself. A median of 4 units of red blood cells was transfused. Nearly 80% of patients did not require perioperative transfusion and there was a consistent decline in the need for transfusion over time.…”