Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma.

Journal

HPB : the official journal of the International Hepato Pancreato Biliary Association
ISSN: 1477-2574
Titre abrégé: HPB (Oxford)
Pays: England
ID NLM: 100900921

Informations de publication

Date de publication:
16 Jul 2024
Historique:
received: 29 04 2024
revised: 21 06 2024
accepted: 11 07 2024
medline: 15 9 2024
pubmed: 15 9 2024
entrez: 14 9 2024
Statut: aheadofprint

Résumé

Major hepatectomy in perihilar cholangiocarcinoma (pCCA) patients with a small future liver remnant (FLR) risks posthepatectomy liver failure (PHLF). This study examines combined portal and hepatic vein embolisation (PVE/HVE) to increase preoperative FLR volume and potentially decrease PHLF rates. In this retrospective, multicentre, observational study, data was collected from centres affiliated with the DRAGON Trials Collaborative and the EuroLVD registry. The study included pCCA patients who underwent PVE/HVE between July 2016 and January 2023. Following PVE/HVE, 28% of patients (9/32) experienced complications, with 22% (7/32) necessitating biliary interventions for cholangitis. The median degree of hypertrophy after a median of 16 days was 16% with a kinetic growth rate of 6.8% per week. 69% of patients (22/32) ultimately underwent surgical resection. Cholangitis after PVE/HVE was associated with unresectability. After resection, 55% of patients (12/22) experienced complications, of which 23% (5/22) were Clavien-Dindo grade III or higher. The 90-day mortality after resection was 0%. PVE/HVE quickly enhances the kinetic growth rate in pCCA patients. Cholangitis impairs chances on resection significantly. Resection after PVE/HVE is associated with low levels of 90-day mortality. The study highlights the potential of PVE/HVE in improving safety and outcomes in pCCA undergoing resection.

Sections du résumé

BACKGROUND BACKGROUND
Major hepatectomy in perihilar cholangiocarcinoma (pCCA) patients with a small future liver remnant (FLR) risks posthepatectomy liver failure (PHLF). This study examines combined portal and hepatic vein embolisation (PVE/HVE) to increase preoperative FLR volume and potentially decrease PHLF rates.
METHODS METHODS
In this retrospective, multicentre, observational study, data was collected from centres affiliated with the DRAGON Trials Collaborative and the EuroLVD registry. The study included pCCA patients who underwent PVE/HVE between July 2016 and January 2023.
RESULTS RESULTS
Following PVE/HVE, 28% of patients (9/32) experienced complications, with 22% (7/32) necessitating biliary interventions for cholangitis. The median degree of hypertrophy after a median of 16 days was 16% with a kinetic growth rate of 6.8% per week. 69% of patients (22/32) ultimately underwent surgical resection. Cholangitis after PVE/HVE was associated with unresectability. After resection, 55% of patients (12/22) experienced complications, of which 23% (5/22) were Clavien-Dindo grade III or higher. The 90-day mortality after resection was 0%.
CONCLUSION CONCLUSIONS
PVE/HVE quickly enhances the kinetic growth rate in pCCA patients. Cholangitis impairs chances on resection significantly. Resection after PVE/HVE is associated with low levels of 90-day mortality. The study highlights the potential of PVE/HVE in improving safety and outcomes in pCCA undergoing resection.

Identifiants

DOI: 10.1016/j.hpb.2024.07.407 PMID: 39277435
pubmed: 39277435
pii: S1365-182X(24)02219-6
doi: 10.1016/j.hpb.2024.07.407
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Investigateurs

Patrick Chevallier (P)
Stephen Wigmore (S)
Timothy Newhook (T)
Jean-Nicolas Vauthey (JN)
Riccardo Memeo (R)
Bobby Vm Dasari (BV)
Eva Braunwarth (E)
Luca Aldrighetti (L)
Laurens van Baardewijk (L)
Louise Barbier (L)
Christoph Binkert (C)
Bergthor Björnsson (B)
Esteban Cugat Andorrà (EC)
Bulent Arslan (B)
Ivan Baclija (I)
Marc Bemelmans (M)
Clare Bent (C)
Marieke T de Boer (MT)
Reinoud P H Bokkers (RPH)
Diederick de Boo (D)
David Breen (D)
Stefan Breitenstein (S)
Philipp Bruners (P)
Alberta Cappelli (A)
Ulrik Carling (U)
Margarida Casellas I Robert (M)
Benjamin Chan (B)
Franceso De Cobelli (F)
Charles Cha (C)
Julian Choi (J)
Michael Crawford (M)
Daniel Croagh (D)
Ronald van Dam (R)
Fabrice Deprez (F)
Olivier Detry (O)
Maxime Dewulf (M)
Rafael Díaz-Nieto (R)
Alexandra Dili (A)
Joris I Erdmann (JI)
Jaume Codina Font (JC)
Rob Davis (R)
Martin Delle (M)
Rukshan Fernando (R)
None Oliver Fisher
Suomi Fouraschen (S)
Åsmund A Fretland (ÅA)
Yilian Fundora (Y)
Arantxa Gelabert (A)
Laurent Gerard (L)
Paul Gobardhan (P)
Fernando Gómez (F)
Felice Guiliante (F)
Thomas Gruenberger (T)
Lukasz Filip Grochola (LF)
Dirk Grünhagen (D)
Josep Guitart Giménez (JG)
Jeroen Hagendoorn (J)
Jan Heil (J)
Daniel Heise (D)
Eric Herrero (E)
Gebriel Hess (G)
Mohammed Abu Hilal (MA)
Martin Hoffmann (M)
Roberto Iezzi (R)
Farshad Imani (F)
Nakarin Inmutto (N)
Sinead James (S)
Francisco Javier Garcia Borobia (FJ)
Elio Jovine (E)
Jennifer Kalil (J)
Peter Kingham (P)
Otto Kollmar Clarunis (OK)
Jörg Kleeff (J)
Christiaan van der Leij (C)
Santiago Lopez-Ben (S)
Andrew Macdonald (A)
Martijn Meijerink (M)
Remon Korenblik (R)
Worakitti Lapisatepun (W)
Wouter Leclercq (W)
Richard Lindsay (R)
Valerio Lucidi (V)
David C Madoff (DC)
Guillaume Martel (G)
Homoyon Mehrzad (H)
Krishna Menon (K)
Peter Metrakos (P)
Sachin Modi (S)
Adriaan Moelker (A)
Nicola Montanari (N)
Jaume Sampere Moragues (JS)
Jordi Navinés López (JN)
Ulf Neumann (U)
Julian Nguyen (J)
Praveen Peddu (P)
John Primrose (J)
Steven Olde Damink (SO)
Xudong Qu (X)
Dimitri A Raptis (DA)
Francesca Ratti (F)
Stephen Ryan (S)
Fourat Ridouani (F)
Inne H M Borel Rinkes (IHM)
Chris Rogan (C)
Ulrich Ronellenfitsch (U)
Matteo Serenari (M)
Aysun Salik (A)
Claudio Sallemi (C)
Per Sandström (P)
Ernesto Santos Martin (ES)
Luis Sarría (L)
Erik Schadde (E)
Alejandro Serrablo (A)
Utz Settmacher (U)
Jens Smits (J)
Maarten Smits (M)
Andreas Snitzbauer (A)
Zahir Soonawalla (Z)
Ernesto Sparrelid (E)
Elmar Spuentrup (E)
Gregor Stavrou (G)
Robert Sutcliffe (R)
Ilario Tancredi (I)
Jordan C Tasse (JC)
Ulf Teichgräber (U)
Venkatesha Udupa (V)
David A Valenti (DA)
David Vass (D)
Thomas Vogl (T)
Xiaoying Wang (X)
Steven White (S)
Jean-François De Wispelaere (JF)
Walter Wohlgemuth (W)
Dominic Yu (D)
Ijsbrand Zijlstra (I)

Informations de copyright

Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of interest None to declare.

Auteurs

Jens Smits (J)

Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands.

Steven Chau (S)

Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.

Sinéad James (S)

Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands.

Remon Korenblik (R)

Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands.

Madita Tschögl (M)

Department of Surgery, HPB Centre Vienna Health Network, Clinic Favoriten, Wienerbergstraße 13, 1100, Vienna, Austria.

Pieter Arntz (P)

Department of Surgery, Amsterdam University Medical Centre Location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.

Jan Bednarsch (J)

Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.

Luis Abreu de Carvalho (L)

Department of HPB Surgery and Liver Transplantation, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.

Olivier Detry (O)

Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Avenue de l'Hôpital 1, 4000, Liège, Belgium.

Joris Erdmann (J)

Department of Surgery, Amsterdam University Medical Centre Location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.

Thomas Gruenberger (T)

Department of Surgery, HPB Centre Vienna Health Network, Clinic Favoriten, Wienerbergstraße 13, 1100, Vienna, Austria.

Laurens Hermie (L)

Department of Vascular and Interventional Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.

Ulf Neumann (U)

Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Hufelandstraße 55, 45147, Essen, Germany.

Per Sandström (P)

Department of Surgery in Linköping and Biomedical and Clinical Sciences, Linköping University, Universitetssjukhuset, 581 85 Linköping, Sweden.

Robert Sutcliffe (R)

Department of Surgery, Queen Elizabeth Hospital Birmingham NHS, Mindelsohn Way, Birmingham, B15 2GW, United Kingdom.

Alban Denys (A)

Department of Radiology and Interventional Radiology, CHUV University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.

Emmanuel Melloul (E)

Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.

Maxime Dewulf (M)

Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands. Electronic address: maxime.dewulf@mumc.nl.

Christiaan van der Leij (C)

GROW - School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.

Ronald M van Dam (RM)

Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands; Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany. Electronic address: r.van.dam@mumc.nl.

Classifications MeSH