Mo2032 Small Cell Carcinoma of the Ampulla of Vater

Abstract

[Background/Aim] An extensive hepatic resection is required in cases of malignant hepatic and biliary tract tumor. The prognosis is influenced by a shortage of functional capacity of the remnant liver. Since preoperative portal vein embolization (PVE) was first reported, this technique has become widely used in such cases. However, the indication for PVE and its outcome are unclear. In the present study, we retrospectively analyzed preoperative PVE patients. [Patients] From January 2002 to December 2011, 58 patients underwent preoperative PVE at our institute. In this study, we analyzed 46 patients (29 cases of hilar bile duct cancer [no liver damage group] and 17 colorectal liver metastatic tumor cases after chemotherapy [liver damage group]). In cases of hilar bile duct cancer or colorectal hepatic metastasis, we compared the resection rate and prognosis of these patients before and after PVE introduction. [Results] Two of 46 patients had complications caused by preoperative PVE (minimal bleeding into the biliary tract). Four cases in the group without liver damage (13.8%) could not undergo hepatectomy (3 cases, progressive disease; 1 case, no hypertrophy of the remnant liver). Five cases in the liver damage group (29.4%) could not undergo hepatectomy (1 case, severe steatohepatitis; 4 cases, no hypertrophy of the remnant liver). The median rates of hypertrophy of the remnant liver in the group without liver damage and the liver damage group were 9.4% and 7.5%, respectively (no statistical difference). The median maximum total bilirubin levels after hepatectomy in the group without liver damage and the liver damage group were 4.3 and 1.9 mg/dL, respectively (no statistical difference). In cases of hilar bile duct cancer and colorectal hepatic metastasis, the resection rate and the prognosis improved significantly after PVE introduction (resection rate: 56.7% vs. 90.2% and 30.0% vs. 58.2%, respectively; 3-year survival rate: 35.2% vs. 70.2% and 35.2% vs. 45.2%, respectively). [Conclusion] In the present study, no statistical difference was noted between the liver damage group and the group without liver damage in the rate of hypertrophy of the remnant liver after PVE and postoperative complications. However, the incidence of unresectability because of lack of hypertrophy of the remnant liver was higher in the liver damage group than in the group without liver damage. Thus, we believe that PVE has potential benefits for hilar bile duct cancer patients and colorectal liver metastasis patients because of the associated improved resection rate and prognosis.