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Tumor progression after preoperative portal vein embolization
Lisette T Hoekstra1, Krijn P van Lienden, Ageeth Doets
1Department of Surgery, Academic Medical Center, University of Amsterdam, Meibregdreef 9, Amsterdam, The Netherlands.
Annals of Surgery
|October 26, 2012
Summary
Portal vein embolization (PVE) significantly increases tumor growth rate and the risk of new or recurrent tumors after liver resection. Shorter intervals between PVE and surgery, along with chemotherapy, are recommended to improve outcomes.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Medical imaging
Background:
- Portal vein embolization (PVE) is used to induce hypertrophy of the future remnant liver (FRL) before major liver resection.
- Compensatory liver regeneration after PVE may inadvertently promote tumor growth.
Purpose of the Study:
- To evaluate the impact of PVE on tumor growth rate (TGR) and outcomes in patients with colorectal metastases undergoing liver resection.
Main Methods:
- Retrospective analysis of 28 patients who underwent PVE before liver resection for colorectal metastases.
- Tumor volume and TGR were assessed using computed tomography (CT) volumetry before and after PVE.
- Comparison with a control group of 30 non-PVE patients with colorectal metastases.
Main Results:
- PVE patients exhibited a significantly higher median TGR (0.53 mL/d) compared to non-PVE patients (0.09 mL/d).
- New tumor lesions in the FRL were observed in 25% of PVE patients, with 11% becoming unresectable.
- Recurrence rates in the remnant liver were higher in PVE patients (42%) versus non-PVE patients (4%).
- Three-year survival rates were substantially lower for PVE patients (26%) compared to non-PVE patients (77%).
Conclusions:
- PVE is associated with accelerated tumor growth, increased incidence of new tumors in the FRL, and higher rates of recurrence post-resection.
- Recommendations include minimizing the interval between PVE and resection and incorporating interval chemotherapy.
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