Liver Venous Deprivation Versus Portal Vein Embolization Before Major Hepatectomy for Colorectal Liver Metastases: A Retrospective Comparison of Short- and Medium-Term Outcomes.
Future liver remnant
Liver venous deprivation
Major hepatectomy
Portal vein embolization
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
received:
25
04
2022
accepted:
18
11
2022
pubmed:
13
12
2022
medline:
3
3
2023
entrez:
12
12
2022
Statut:
ppublish
Résumé
Liver venous deprivation (LVD) is a recent radiological technique performed to induce hypertrophy of the future liver remnant. Medium-term results of major hepatectomy after LVD have never been compared with the actual standard of care, portal vein embolization (PVE). We retrospectively compared data from 33 consecutive patients who had undergone LVD (n = 17) or PVE (n = 16) prior to a right hemi-hepatectomy or right extended hepatectomy indicated for colorectal liver metastases (CRLM) between May 2015 and December 2019. The 1-year and 3-year overall survival (OS) rates in the LVD group were 81.3% (95% confidence interval [CI]: 72-90) and 54.7% (95% CI: 46-63), respectively, against 85% (95% CI: 69-101) and 77.4% (95% CI: 54-100) in the PVE group; the differences were not statistically significant (p = 0.64). The median disease-free survival (DFS) rate was also comparable: 6 months (95% CI: 4-7) in the LVD group and 12 months (95% CI: 1.5-13) in the PVE group (p = 0.29). The overall intra-operative and post-operative complication rates were similar between the two groups. The mean daily kinetic growth rate (KGR) was found to be higher after LVD than after PVE (0.2% vs. 0.1%, p = 0.05; 10 cc/day vs. 4.8 cc/day, p = 0.03), as was the mean increase in future liver remnant volume (FLR-V) (49% vs. 27%, p = 0.01). The LVD technique is well tolerated in patients undergoing right hemi-hepatectomy or right extended hepatectomy for CRLM. When compared with the PVE technique, the LVD technique has similar peri-operative and medium-term outcomes, but higher KGR and FLR-V increase.
Sections du résumé
BACKGROUND
Liver venous deprivation (LVD) is a recent radiological technique performed to induce hypertrophy of the future liver remnant. Medium-term results of major hepatectomy after LVD have never been compared with the actual standard of care, portal vein embolization (PVE).
METHODS
We retrospectively compared data from 33 consecutive patients who had undergone LVD (n = 17) or PVE (n = 16) prior to a right hemi-hepatectomy or right extended hepatectomy indicated for colorectal liver metastases (CRLM) between May 2015 and December 2019.
RESULTS
The 1-year and 3-year overall survival (OS) rates in the LVD group were 81.3% (95% confidence interval [CI]: 72-90) and 54.7% (95% CI: 46-63), respectively, against 85% (95% CI: 69-101) and 77.4% (95% CI: 54-100) in the PVE group; the differences were not statistically significant (p = 0.64). The median disease-free survival (DFS) rate was also comparable: 6 months (95% CI: 4-7) in the LVD group and 12 months (95% CI: 1.5-13) in the PVE group (p = 0.29). The overall intra-operative and post-operative complication rates were similar between the two groups. The mean daily kinetic growth rate (KGR) was found to be higher after LVD than after PVE (0.2% vs. 0.1%, p = 0.05; 10 cc/day vs. 4.8 cc/day, p = 0.03), as was the mean increase in future liver remnant volume (FLR-V) (49% vs. 27%, p = 0.01).
CONCLUSIONS
The LVD technique is well tolerated in patients undergoing right hemi-hepatectomy or right extended hepatectomy for CRLM. When compared with the PVE technique, the LVD technique has similar peri-operative and medium-term outcomes, but higher KGR and FLR-V increase.
Identifiants
pubmed: 36509901
doi: 10.1007/s11605-022-05551-2
pii: 10.1007/s11605-022-05551-2
pmc: PMC9744374
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
296-305Informations de copyright
© 2022. The Society for Surgery of the Alimentary Tract.
Références
Surgery. 2011 May;149(5):680-8
pubmed: 21316725
Cancer Treat Rev. 2015 Nov;41(9):729-41
pubmed: 26417845
HPB (Oxford). 2011 Aug;13(8):528-35
pubmed: 21762295
Ann Surg. 2002 Jun;235(6):759-66
pubmed: 12035031
HPB (Oxford). 2012 Jul;14(7):461-8
pubmed: 22672548
HPB (Oxford). 2015 Jun;17(6):477-84
pubmed: 25728543
Hepatobiliary Surg Nutr. 2021 Jun;10(3):350-363
pubmed: 34159162
Ann Surg. 2020 Aug;272(2):199-205
pubmed: 32675481
Gut. 2021 Jan;70(1):114-126
pubmed: 32482683
Hepatobiliary Surg Nutr. 2021 Apr;10(2):270-272
pubmed: 33898575
Hepatobiliary Surg Nutr. 2020 Oct;9(5):564-576
pubmed: 33163507
Surg Oncol. 2022 Aug;43:101812
pubmed: 35820263
Cardiovasc Intervent Radiol. 2013 Feb;36(1):25-34
pubmed: 22806245
Cancer Med. 2019 Oct;8(14):6165-6175
pubmed: 31464101
J Clin Oncol. 2005 Nov 20;23(33):8490-9
pubmed: 16230676
Surgery. 2018 Jun;163(6):1257-1263
pubmed: 29502872
N Engl J Med. 2007 Apr 12;356(15):1545-59
pubmed: 17429086
World J Hepatol. 2016 Mar 28;8(9):439-45
pubmed: 27028706
HPB (Oxford). 2002;4(2):99; author reply 99-100
pubmed: 18332933
Br J Radiol. 2006 Jun;79(942):473-8
pubmed: 16714748
Ann Surg Oncol. 2016 Oct;23(11):3709-3717
pubmed: 27272106
Hepatology. 2003 Jul;38(1):258-66
pubmed: 12830009
BMC Cancer. 2014 Nov 04;14:810
pubmed: 25369977
Tech Vasc Interv Radiol. 2009 Jun;12(2):162-70
pubmed: 19853234
World J Clin Cases. 2018 Nov 26;6(14):716-734
pubmed: 30510936
J Gastrointest Surg. 2017 Oct;21(10):1754-1755
pubmed: 28785933
Gut. 2005 Feb;54(2):289-96
pubmed: 15647196
Minerva Surg. 2022 Aug;77(4):368-379
pubmed: 35332767
J Am Coll Surg. 2010 May;210(5):744-52, 752-5
pubmed: 20421043
J Am Coll Surg. 2013 Feb;216(2):201-9
pubmed: 23219349
Saudi J Anaesth. 2019 Apr;13(Suppl 1):S31-S34
pubmed: 30930717
Eur Radiol. 2017 Aug;27(8):3343-3352
pubmed: 28101681
Biom J. 2014 Jan;56(1):129-40
pubmed: 24395208
Ann Surg. 2009 Aug;250(2):187-96
pubmed: 19638912
Eur Radiol. 2016 Dec;26(12):4259-4267
pubmed: 27090112
Ann Oncol. 2016 Aug;27(8):1386-422
pubmed: 27380959
Hepatobiliary Surg Nutr. 2019 Aug;8(4):329-337
pubmed: 31489302
Cancers (Basel). 2021 Jan 08;13(2):
pubmed: 33429913
Ann Transl Med. 2020 Oct;8(19):1259
pubmed: 33178791
Liver Transpl. 2002 Mar;8(3):233-40
pubmed: 11910568
Surgery. 2020 Jun;167(6):917-923
pubmed: 32014304
Surgery. 2011 May;149(5):713-24
pubmed: 21236455