Abstract
Background. Some patients cannot undergo curative surgical procedures for liver metastases because
of the risk of severe postoperative hepatic failure, which stems from a too-small
future remaining liver (FRL). Preoperative portal vein embolization (PVE) is an effective
means of creating hypertrophy of the FRL, thus permitting safe hepatic resection.
The aim of this retrospective study was to investigate the long-term results of this
technique. Methods. Sixty-eight patients underwent PVE. Of those, 60 (88%) subsequently underwent hepatic
resection. Indication for PVE was an estimated FRL ratio (assessed by volumetric computed
tomography) of less than 30%. However, if the patient had undergone multiple courses
of chemotherapy, the threshold was 40%. The origin of the primary neoplasm was colorectal
in 41 patients (68%); in the remaining 19 (32%), the primary neoplasms originated
at other sites. Results. Mean growth of the estimated FRL measured by computed tomography 1 month after PVE
was 13%. Major complications after hepatectomy occurred in 27% of the patients, and
the operative mortality rate was 3%. For the 60 patients who underwent PVE followed
by hepatic resection, the 5-year overall survival rate and the disease-free survival
rate were 34% and 24%, respectively. The 5-year overall survival rate and the disease-free
survival rate of patients with colorectal metastases only were 37% and 21%, respectively.
Conclusions. The long-term survival rate after PVE followed by resection is comparable with the
survival rate obtained after resection without preoperative PVE. The 5-year survival
rate of patients undergoing PVE followed by hepatectomy justifies the use of this
technique. This technique thus increases the suitability of resection as a treatment
choice for patients with liver metastases. PVE should number among the therapeutic
options available to every hepatic surgeon. (Surgery 2002;131:294-9.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Long-term survival following resection of colorectal hepatic metastases.Br J Surg. 1997; 84: 977-980
- Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection.Surgery. 1988; 103: 278-288
- Resection of colorectal metastases.World J Surg. 1995; 19: 59-71
- Preoperative portal vein embolization for hepatocellular carcinoma.World J Surg. 1986; 10: 803-808
- Preoperative portal embolization to increase safety a major hepatectomy for hilar bile duct carcinoma: a preliminary report.Surgery. 1990; 107: 521-527
- New possibilities for major liver surgery in patients with Klatskin tumors or primary hepatocellular carcinoma: an old problem revisited.Hepatogastroenterology. 1991; 38: 329-336
- Extension of surgical indications for hepatocellular carcinoma by portal vein embolization.World J Surg. 1993; 17: 109-115
- Radical operation after portal embolization for tumor of hilar bile duct.J Am Coll Surg. 1994; 178: 480-486
- Resection for multiple metastatic liver tumors after portal embolization.Surgery. 1994; 115: 674-677
- Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma.Surgery. 1995; 117: 677-681
- Right portal vein embolization in preparation for major hepatic resection.J Am Coll Surg. 1995; 181: 267-269
- Embolisation portale pré-opératoire avant hépatectomie sur foie cirrhotique: tolérance biologique, clinique et résultats volumétriques chez 9 patients. Résumés J. Francophones de Gastroenterol. Strasbourg.Gastroenterol Clin Biol. 1998; 22: A131
- Measurement of liver and spleen volume by computed tomography.Radiology. 1981; 141: 525-527
- 150 résections hépatiques pour tumeur malignes: aspects techniques.J Chir (Paris). 1990; 127: 27-34
- Prolonged intermittent clamping of the portal triad during hepatectomy.Br J Surg. 1991; 78: 42-44
- Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy.Br J Surg. 1995; 82: 1535-1539
- Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization.Ann Surg. 2000; 231: 480-486
- Quelles sont les indications réelles des hépatectomies pour métastases d'origine colo-rectales?.Gastroenterol Clin Biol. 1998; 22: 1048-1055
- Liver resection for colorectal metastases.J Clin Oncol. 1997; 15: 938-946
- Hepatic resection for metastatic colorectal cancer results in cure for some patients.Arch Surg. 1997; 132: 505-511
- Resection of liver metastases: when is it worthwhile?.World J Surg. 1987; 11: 511-520
- Portal vein embolization: rationale, technique and future prospects.Br J Surg. 2001; 88: 165-175
- Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure.J Am Coll Surg. 1989; 169: 17-26
- Frequency, technical aspects, results, and indications of major hepatectomy after prolonged intra-arterial hepatic chemotherapy for initially unresectable hepatic tumors.J Am Coll Surg. 1995; 180: 213-219
- Preoperative portal vein embolization: an audit of 84 patients.Hepatology. 1999; 29: 1099-1105
- Changes in hepatic lobar function after right portal vein embolization.Ann Surg. 1996; 223: 77-83
- Embolization of portal vein branches induces hepatocyte replication in swine: a potential step in hepatic gene therapy.Radiology. 1999; 210: 467-477
- Changes in clinicopathological findings after portal vein embolization.Hepatogastroenterology. 2000; 47: 1560-1563
Article info
Publication history
Accepted:
September 6,
2001
Footnotes
*Reprint requests: Dominique Elias, MD, Department de Chirurgie Oncologique, Institut Gustave Roussy, Rue Camille Desmoulins, Villejuif, Cedex 94805, France.
Identification
Copyright
© 2002 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
