Portal vein embolization with stem cells application for increasing future liver remnant volume in primary 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 with application of autologous hematopoietic stem cells (PVEHSC) are possible methods for stimulation of FLRV growth. Methods: PVEHSC was used in 24 patients with primary non-resectable CLM due to insufficient FLRV.PVE was performed on the site of CLMs.HSC were received in the first eleven patients via apheresis after a four-day stimulation by granulocyte-colony stimulating factor and in the following 13 patients from bone marrow and prepared by centrifugation at the same time. The product was applied via vena ileocolica to the contralateral liver lobe,which was free of CLM. Liver resection was performed as soon as after sufficient growth of FRLV. Results: Procedure morbidity and mortality was zero. Sufficient FLRV developed in all patients in the interval of three weeks. The median of FLRV enlargement was 181 ml and average FLRV growth was 3.4 ml/day. The average growth of CLM volume was 41.5 ml, resp. 0.9 ml/ day.R0 right hepatectomy was performed in 20 patients (83.3 %), exploratory laparotomy in four patients (3x tumor progression, 1x severe adhesions). One and three years OS was 76.6, resp. 50.3%, DFI 67.2, resp.32.1% in patients after liver resection. More than three CLM were the only significant factor for DFI (p<0.04). Conclusion: PVEHSC is a safe and promising method for increasing FLRV in patients with primary non-resectable CLM.