Comparison of portal vein embolization (PVE) with PVE and mesenchymal stem cell application effectivity for future remnant liver volume growth in patients with primarily non-resectable colorectal liver metastases

Abstract

Background: Insufficient future liver remnant volume (FLRV) is the main cause of non-resectability of colorectal liver metastases (CLM). Portal vein embolization (PVE) and PVE with autologous mesenchymal stem cell application (PVE+MSC) are methods used for increase of FLRV. The aim of study was to compare both methods from the aspect of FLRV growth, CLM progression, resectability and long-term Results. Methods: From 6/2010 to 6/2018 fifty-six patients with CLM and insufficient FLRV were included in the retrospective consecutive study. PVE (histoacryl and lipiodol mixture 1:10) was performed in 28 and PVE + MSC (from peripheral blood and bone marrow) in 28 patients. FLVR growth and CLM volume were evaluated using computed tomography. Liver function was evaluated by indocyanine green retention test. Liver resection was performed in patients with FLVR > 30% of total liver volume. Results: In the PVE group, FLRV growth was observed in 24 patients (85.7%), in the PVE+MSC group in 100% of patients (p< 0.05). The rapidity of FLRV and CLM growth did not differ in both groups. R0 resection was performed in 14 (50.0%) and 24 (85.7%) patients from the PVE and PVE+MSC (p<0.02) groups respectively. The 3-year overall survival and progression free survival was 85.7 and 9.3% respectively in the PVE and 68.7% and 17.1% respectively in the PVE+MSC group (NS). Conclusions: Both methods are useful procedures for stimulation of FLRV growth in patients with CLM, but PVE+MSC is more effective enabling higher resectability rate of CLM. Both methods do not differ in the long-term results.