Abstract
Simple SummaryIn the original retrospective study entitled “Oncological outcomes after Liver Venous Deprivation for Colorectal Liver Metastases: a single center experience” the authors report for the first time the oncological outcomes of Liver Venous Deprivation (LVD) for Colorectal Liver Metastases. LVD is an interventional radiologic technique recently employed before major liver resections and has already showed its safety and effectiveness in inducing contralateral liver hypertrophy. Seventeen consecutive patients undergoing LVD between July 2015 and May 2020 before a right (or extended right) hepatectomy were retrospectively analyzed from an institutional database. The 1-year and 3-year overall survival (OS), as well as hepatic recurrence and Disease Free Survival (DFS), were comparable to literature reports of portal vein embolization (PVE) oncological outcomes.Colorectal liver metastases (CRLM) are the major cause of death in patients with colorectal cancer (CRC). The cornerstone treatment of CRLM is surgical resection. Post-operative morbidity and mortality are mainly linked to an inadequate future liver remnant (FLR). Nowadays preoperative portal vein embolization (PVE) is the most widely performed technique to increase the size of the future liver remnant (FLR) before major hepatectomies. One method recently proposed to increase the FLR is liver venous deprivation (LVD), but its oncological impact is still unknown. The aim of this study is to report first short- and long-term oncological outcomes after LVD in patients undergoing right (or extended right) hepatectomy for CRLM. Seventeen consecutive patients undergoing LVD between July 2015 and May 2020 before an (extended) right hepatectomy were retrospectively analyzed from an institutional database. Post-operative and follow-up data were analyzed and reported. Primary outcomes were 1-year and 3-year overall survival (OS) and hepatic recurrence (HR). Postoperative complications occurred in 8 patients (47%). No deaths occurred after surgery. HR occurred in 9 patients (52.9%). 1-year and 3-year OS were 87% (95% confidence interval [CI]: ±16%) and 60.3%, respectively (95% CI: ±23%). Median Disease-Free Survival (DFS) was 6 months (CI 95%: 4.7–7.2). With all the limitations of a retrospective study with a small sample size, LVD showed similar oncological outcomes compared to literature reports for Portal Vein Embolization (PVE).
Highlights
Liver resection is considered the mainstay of Colo-Rectal Liver Metastases (CRLM) treatment with excellent long-term oncological outcomes, and low morbidity and mortality [1,2]
Over the past 5 years, a new radiological interventional technique of liver venous deprivation (LVD) has emerged. It consists of simultaneous embolization of portal vein and one or two hepatic veins, in order to increase the damage to the liver leading to increased hypertrophy of the contralateral parenchyma [16,17,18], with a kinetic growth rate of 16 ± 7 cc/day according to first reports [19]
There is a considerable interest in this issue, as evidenced by several papers that speculate about negative effects of similar radiological liver augmentation procedures, such as portal vein embolization (PVE), on tumor growth [21]
Summary
Liver resection is considered the mainstay of Colo-Rectal Liver Metastases (CRLM) treatment with excellent long-term oncological outcomes, and low morbidity and mortality [1,2]. PVE does not always induce sufficient and rapid hypertrophy, yielding a 20% rate of not eligibility to resection due to either insufficient FLR or patient’s dropout for tumor progression [11] To overcome these limitations, new surgical procedures were recently introduced: the associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) [12], the Radio-frequency-Assisted Liver Partition with Portal vein ligation (RALPP) [13] and the Associating Liver Tourniquet and right Portal occlusion for Staged hepatectomy (ALTPS) [14]. Over the past 5 years, a new radiological interventional technique of liver venous deprivation (LVD) has emerged It consists of simultaneous embolization of portal vein and one or two hepatic veins, in order to increase the damage to the liver leading to increased hypertrophy of the contralateral parenchyma [16,17,18], with a kinetic growth rate of 16 ± 7 cc/day according to first reports [19]. There is a considerable interest in this issue, as evidenced by several papers that speculate about negative effects of similar radiological liver augmentation procedures, such as PVE, on tumor growth [21]
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