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Tumor Progression After Preoperative Portal Vein Embolization

Hoekstra, Lisette T. MD*; van Lienden, Krijn P. MD; Doets, Ageeth*; Busch, Olivier R.C. MD, PhD*; Gouma, Dirk J. MD, PhD*; van Gulik, Thomas M. MD, PhD*

doi: 10.1097/SLA.0b013e3182733f09
Original Articles From the ESA Proceedings

Objective: To evaluate tumor growth in a series of patients undergoing liver resection after portal vein embolization (PVE).

Background: The regenerative response after PVE leading to compensatory hypertrophy of the nonembolized liver segments potentially enhances tumor growth.

Methods: Portal vein embolization was performed in 28 patients diagnosed with colorectal metastases between 2004 and 2011. Tumor volume was measured by computed tomography (CT) volumetry before and after PVE. Tumor growth rate (TGR) was measured by CT volumetry and compared with that of a non-PVE control group with colorectal metastases of whom 30 had 2 CT scans preoperatively. Also, newly diagnosed tumors in the future remnant liver (FRL) after PVE and after resection were analyzed.

Results: The median TGR of PVE patients was 0.53 mL/d (interquartile range [IQR], 0.02–1.88) versus 0.09 mL/d (IQR, −0.04 to 0.40; P = 0.03) in non-PVE patients. The TGR was 0.15 (IQR, −0.52 to 0.66) mL/d before PVE and 0.85 (IQR, −0.10 to 1.62) mL/d after PVE in the same patients (P = 0.03). Seven patients (25%) showed new tumor lesions in the FRL after PVE, of whom 3 patients (11%) were not resectable. Patients (8 of 19; 42%) after PVE also showed a higher rate of recurrent metastases in the remnant liver at follow-up than non-PVE patients (1 of 28; 4%). Survival was significantly better for non-PVE patients, with a 3-year survival rate of 77% versus 26% in patients undergoing PVE.

Conclusions: Portal vein embolization is associated with increased TGR and new tumor in the FRL and recurrent tumor after resection. Short intervals and interval chemotherapy between PVE and resection are, therefore, advised.

Tumor growth rate was higher in patients undergoing liver resection after portal vein embolization (PVE) than in patients who did not undergo PVE before resection. New tumors in the future remnant liver and recurrent tumors after resection were noted in the PVE group. Short intervals and chemotherapy between PVE and resection are, therefore, advised.

*Departments of Surgery

Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Reprints: Thomas M. van Gulik, MD, PhD, Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail: t.m.vangulik@amc.uva.nl.

Type of study: retrospective study.

Disclosure: The authors declare that there is nothing to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.