Portal vein embolization extends indications for hemihepatectomy in liver cancer patients

Last Updated: 2016-04-15

By Reuters Staff

NEW YORK (Reuters Health) - Portal vein embolization (PVE) may safely enable more patients to undergo right-side hemihepatectomy for hepatocellular cancer (HCC), researchers from Japan report.

PVE is commonly employed to provide a larger future functional remnant liver volume for patients undergoing major hepatectomy, but its oncologic effects are not fully understood.

Dr. Toru Beppu from Kumamoto University and colleagues assessed the impact of preoperative PVE on the recurrence and long-term prognosis of 510 HCC patients treated with right-side hemihepatectomy. One hundred sixty-two had PVE, while the remainder did not.

PVE reduced the proportion of resected liver volume (RLV) from 60.5% to 50.3% (p<0.001), making it similar to that of the non-PVE group (48.3%), the team reports in the Journal of the American College of Surgeons, online March 25.

Median operation time was significantly longer in the PVE group (417 min) than in the non-PVE group (393 min), but morbidity was no different, and there were no specific postoperative complications.

Thirty-day and 90-day mortality did not differ between the PVE group (2.0% for both intervals) and the non-PVE group (1.4% and 2.7%, respectively).

Relapse-free (RFS) and overall survival (OS) were significantly greater in the PVE group than in the non-PVE group in unadjusted analyses, but in propensity score-matched comparisons, RFS and OS did not differ significantly between the groups.

The incidence of recurrence overall and within two years of surgery was similar between the two groups, though extrahepatic recurrences were encountered more frequently in the non-PVE group than in the PVE group (38.8% vs. 18.1%, p=0.004).

Morbidity, multiple tumors, red cell transfusion, greater age, and massive portal invasion independently predicted RFS, and the same factors (except transfusion and age) independently predicted OS.

"PVE can assure liver regeneration and extend the indications of right-side hemihepatectomy for HCC patients without perioperative disadvantage, with the exception of prolonging the operation time," the researchers conclude. "In addition, RFS and OS were quite comparable in patients with or without PVE, and extrahepatic recurrences can be decreased by PVE."

"It would be advisable to design a randomized controlled trial to compare the recurrence and prognosis for initially resectable HCC patients with or without PVE," they add.

Dr. Beppu did not respond to a request for comment.

SOURCE: http://bit.ly/1Vu2uWe

J Am Coll Surg 2016.