Role of Portal Vein Embolization Alone in Surgical Management of Locally Advanced Gall Bladder Cancer (PROVE-GBC): A...

Curative resections are the cornerstone in the management of patients with resectable locally advanced gallbladder cancer (LAGBC). Portal vein embolization (PVE) is a frequently used approach for future liver remnant (FLR) hypertrophy prior to extended hepatectomies. This study was conducted to assess the clinical utility of PVE in patients with LAGBC requiring major hepatectomy. This prospective study included all patients of LAGBC requiring major liver resection who underwent PVE from August 2015 to July 2021. The technical and clinical success rates and the peri-procedural complications of PVE and hypertrophy of FLR after PVE were evaluated along with the assessment and comparison of survival rates in patients with and without definitive surgery. Thirty-five patients (mean age 46.1 years; 18 males) of LAGBC were included in the study. The technical success of PVE was 100%. Post-PVE imaging was performed for 28 patients, of whom 10 had progressive disease. Only 18 patients showed surgically resectable disease on post-PVE imaging. The median percentage of FLR volume increased from 19.6 to 26.2% after PVE (p < 0.01). Nine of the 18 patients could not be operated in view of poor general condition. Out of nine patients who underwent staging laparoscopy, four had distant metastasis intraoperatively. Five patients underwent modified extended right hepatectomy including the resection of segment V, VI, VII, VIII, and IVB with partial caudate lobe excision. The median overall survival in the resectable group was 15 months compared to 5 months in the unresectable cohort (p < 0.01). In patients with LAGBC, PVE alone did not translate into clinical success due to disease progression during the waiting period for FLR hypertrophy.