Portal vein embolization before liver resection for perihilar cholangiocarcinoma reduces the risk of liver failure and perioperative mortality

Abstract

This abstract is authored by the ‘Perihilar cholangiocarcinoma collaboration group’ consisting of 18 centers. Introduction: Portal vein embolization (PVE) has been the standard to improve future remnant liver volume (FLRV) and to reduce the risk of liver failure before major liver resection for almost three decades. Although proven effective in large series there currently is no data on its effectiveness in patients with perihilar cholangiocarcinoma (PHC). This paper aimed to assess postoperative outcomes of portal vein embolization after resection for suspected PHC in a large international, multicentric cohort. Methods: A total of 1433 patients underwent resection of suspected PHC across 18 centers worldwide. Liver failure, biliary leakage and hemorrhage were classified according to the respective ISGLS criteria. Using propensity scoring two equal cohorts of 98 patients were generated using the matching parameters: age, gender, ASA classification, jaundice, type of biliary drainage, baseline FRLV, resection type, and portal vein resection. Results: In the 270 patients who underwent preoperative PVE the overall incidence of liver failure and 90-day mortality was 22% and 15% as opposed to 12% and 10% in patients without PVE (P < 0.01 p = 0.02). After propensity score matching liver failure was lower in the PVE group (8% versus 35%, p < 0.01), as was biliary leakage (10% versus 34%, P < 0.01), intra-abdominal abscesses (19 versus 33%, P = 0.01), and 90-day mortality (7% versus 18%, P = 0.03)(Table). PVE led to a median increase of 42% (18-59) in absolute FLRV. Discussion: Portal vein embolization increases preoperative FRLV in patients with PHC and is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as integral component in the surgical treatment of PHC.Picture 1Table.