Oncological outcomes of portal vein embolisation followed by major liver resection: a 6-year experience

Abstract

Introduction: Portal Vein Embolisation (PVE) is an important adjunct in the surgical management of patients with extensive colorectal liver metastases (CRLM). Evidence suggests that induction of liver hypertrophy after PVE may promote tumour growth. The aim of this study was to evaluate the impact of PVE on tumour growth and report oncological outcomes in patients with CRLM. Methods: Patients who underwent PVE and major liver resection for CRLM between 2009 - 2015 were identified and CT volumetric studies were performed. Post-operative morbidity was defined as the percentage of Clavien-Dindo grade≥III post-operative complications. Values are presented either as mean±SD or median(IQR). Results: PVE was successfully performed in 62 patients and a 9.8±6.3% increase of the future liver remnant was achieved, p=0.0001. There was no PVE associated morbidity. Tumour growth was observed in 40% and 23% of embolised and non-embolised liver lobes respectively (p=0.463). However, on paired analysis no statistical difference was identified in tumour volumes pre and post PVE in both lobes, (p=0.582/p=0.378). 3(4.8%) patients developed new disease after PVE and resection was not feasible. Either one (83.9%) or second stage (11.3%) liver resection was performed in 6(3) weeks post PVE. Postoperative morbidity was 9.7%(n=6) and in-hospital mortality was 0%. Follow up was 3.3±4.1 years and local disease recurrence was 22%(n=13). Three and five-year survival rates were 68.5% and 46.3% respectively. Conclusions: Although PVE combined with major liver resection appears to have favourable oncological outcomes in patients with extensive CRLM, concerns may raise regarding its role in disease progression.