Extended Hepatectomy in Patients With Hepatobiliary Malignancies With and Without Preoperative Portal Vein Embolization | Gastrointestinal Surgery | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Scheele  JStang  RAltendorf-Hofmann  APaul  M Resection of colorectal liver metastases.  World J Surg. 1995;1959- 71Google ScholarCrossref
Fong  YFortner  JSun  RLBrennan  MFBlumgart  LH Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.  Ann Surg. 1999;230309- 318Google ScholarCrossref
Burke  ECJarnagin  WRHochwald  SN  et al.  Hilar cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system.  Ann Surg. 1998;228385- 394Google ScholarCrossref
Neuhaus  PJonas  SBechstein  WO  et al.  Extended resections for hilar cholangiocarcinoma.  Ann Surg. 1999;230808- 819Google ScholarCrossref
Bilimoria  MMLauwers  GYDoherty  DA  et al.  Underlying liver disease, not tumor factors, predicts long-term survival after resection of hepatocellular carcinoma.  Arch Surg. 2001;136528- 535Google ScholarCrossref
Vauthey  JNKlimstra  DFranceschi  D  et al.  Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma.  Am J Surg. 1995;16928- 35Google ScholarCrossref
Fan  STNg  IOPoon  RT  et al.  Hepatectomy for hepatocellular carcinoma: the surgeon's role in long-term survival.  Arch Surg. 1999;1341124- 1130Google ScholarCrossref
Tsao  JILoftus  JPNagorney  DMAdson  MAIlstrup  DM Trends in morbidity and mortality of hepatic resection for malignancy: a matched comparative analysis.  Ann Surg. 1994;220199- 205Google ScholarCrossref
Vauthey  JNBaer  HUGuastella  TBlumgart  LH Comparison of outcome between extended and nonextended liver resections for neoplasms.  Surgery. 1993;114968- 975Google Scholar
Cunningham  JDFong  YShriver  C  et al.  One hundred consecutive hepatic resections: blood loss, transfusion, and operative technique.  Arch Surg. 1994;1291050- 1056Google ScholarCrossref
Melendez  JFerri  EZwillman  M  et al.  Extended hepatic resection: a 6-year retrospective study of risk factors for perioperative mortality.  J Am Coll Surg. 2001;19247- 53Google ScholarCrossref
Makuuchi  MThai  BLTakayasu  K  et al.  Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report.  Surgery. 1990;107521- 527Google Scholar
Kubota  KMakuuchi  MKusaka  K  et al.  Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors.  Hepatology. 1997;261176- 1181Google Scholar
Azoulay  ECastaing  DSmail  A  et al.  Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization.  Ann Surg. 2000;231480- 486Google ScholarCrossref
Vauthey  JNChaoui  ADo  KA  et al.  Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations.  Surgery. 2000;127512- 519Google ScholarCrossref
Abdalla  EKHicks  MEVauthey  JN Portal vein embolization: rationale, technique and future prospects.  Br J Surg. 2001;88165- 175Google ScholarCrossref
Vauthey  JNAbdalla  EKDoherty  DA  et al.  Body surface area and body weight predict total liver volume in Western adults.  Liver Transpl. 2002;8233- 240Google ScholarCrossref
Heymsfield  SBFulenwider  TNordlinger  B  et al.  Accurate measurement of liver, kidney, and spleen volume and mass by computerized axial tomography.  Ann Intern Med. 1979;90185- 187Google ScholarCrossref
Henderson  JMHeymsfield  SBHorowitz  JKutner  MH Measurement of liver and spleen volume by computed tomography: assessment of reproducibility and changes found following a selective distal splenorenal shunt.  Radiology. 1981;141525- 527Google Scholar
Soyer  PRoche  AElias  DLevesque  M Hepatic metastases from colorectal cancer: influence of hepatic volumetric analysis on surgical decision making.  Radiology. 1992;184695- 697Google Scholar
Madoff  DCHicks  MEAbdalla  EKVauthey  JN Portal vein embolization using polyvinyl alcohol and coils in preparation for major liver resection for hepatobiliary malignancy.  Radiology. In press.Google Scholar
Elias  DDe Baere  TRoche  A  et al.  During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma.  Br J Surg. 1999;86784- 788Google ScholarCrossref
Strasberg  SMfor the International Hepato-Pancreato-Biliary Association Terminology Committee Survey, The Brisbane 2000 Terminology of Liver Anatomy and Resections.  HPB. 2000;2333- 339Google Scholar
Kaplan  EMeier  P Nonparametric estimation from incomplete observations.  J Am Stat Assoc. 1958;53457- 481Google ScholarCrossref
Not Available, S-Plus 5 for Unix Guide to Statistics.  Seattle, Wash Data Analysis Products Division1998;
Not Available, StatXact for Windows User Manual.  Cambridge, Mass Cytel Software Corp1997;
Belghiti  JHiramatsu  KBenoist  S  et al.  Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection.  J Am Coll Surg. 2000;19138- 46Google ScholarCrossref
Nagino  MNimura  YKamiya  J  et al.  Right or left trisegment portal vein embolization before hepatic trisegmentectomy for hilar bile duct carcinoma.  Surgery. 1995;117677- 681Google ScholarCrossref
Ijichi  MMakuuchi  MImamura  HTakayama  T Portal embolization relieves persistent jaundice after complete biliary drainage.  Surgery. 2001;130116- 118Google ScholarCrossref
Uesaka  KNimura  YNagino  M Changes in hepatic lobar function after right portal vein embolization: an appraisal by biliary indocyanine green excretion.  Ann Surg. 1996;22377- 83Google ScholarCrossref
Weber  SMJarnagin  WRDeMatteo  RPBlumgart  LHFong  Y Survival after resection of multiple hepatic colorectal metastases.  Ann Surg Oncol. 2000;7643- 650Google ScholarCrossref
Shirabe  KShimada  MGion  T  et al.  Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume.  J Am Coll Surg. 1999;188304- 309Google ScholarCrossref
Vauthey  JNMarsh Rde  WCendan  JCChu  NMCopeland  EM Arterial therapy of hepatic colorectal metastases.  Br J Surg. 1996;83447- 455Google ScholarCrossref
Farley  DRWeaver  ALNagorney  DM "Natural history" of unresected cholangiocarcinoma: patient outcome after noncurative intervention.  Mayo Clin Proc. 1995;70425- 429Google ScholarCrossref
Strasberg  SMDehdashti  FSiegel  BADrebin  JALinehan  D Survival of patients evaluated by FDG-PET before hepatic resection for metastatic colorectal carcinoma: a prospective database study.  Ann Surg. 2001;233293- 299Google ScholarCrossref
Elias  DCavalcanti  Ade Baere  TRoche  ALasser  P Résultats carcinologiques à long terme des hépatectomies réalisées après embolisation portale sélective.  Ann Chir. 1999;53559- 564Google Scholar
June 2002

Extended Hepatectomy in Patients With Hepatobiliary Malignancies With and Without Preoperative Portal Vein Embolization

Author Affiliations

From the Departments of Surgical Oncology (Drs Abdalla, Barnett, Curley, and Vauthey) and Biostatistics (Dr Doherty), The University of Texas MD Anderson Cancer Center, Houston.

Arch Surg. 2002;137(6):675-681. doi:10.1001/archsurg.137.6.675

Hypothesis  Preoperative portal vein embolization (PVE) allows potentially curative hepatic resection without additional morbidity or mortality in patients with hepatobiliary malignancies who are marginal candidates for resection based on small liver remnant size.

Design  A retrospective review of a consecutive series of patients in a multi-institutional database who underwent extended hepatectomy.

Setting  University-based referral centers.

Patients  Forty-two patients underwent preoperative determination of the future liver remnant (FLR) volume before extended hepatectomy (≥5 segments) for hepatobiliary malignancy without chronic underlying liver disease. Patients were stratified by treatment with or without preoperative PVE.

Intervention  Preoperative percutaneous PVE.

Main Outcome Measures  Clinical characteristics, FLR volume, operative morbidity, and survival.

Results  There was no difference between the groups that did and did not undergo PVE for the number of tumors, tumor size, estimated blood loss, duration of the operation, complexity of resection, or surgical margins. The FLR at presentation was significantly smaller in patients who underwent PVE than in patients who did not undergo PVE (18% vs 23%; P<.001). After PVE, FLR volumes increased significantly (P = .003); preoperative FLR volumes were similar in both groups (patients who underwent PVE, 25%; and patients who did not undergo PVE, 23%). There was no perioperative mortality and no statistical difference in the incidence of perioperative complications between those who did and those who did not undergo PVE (5 [28%] of 18 patients vs 5 [21%] of 24 patients). The overall 3-year survival was 65% and the median survival duration was equivalent in the 2 groups (40 vs 52 months for those who did vs those who did not undergo PVE).

Conclusion  Portal vein embolization enables safe and potentially curative extended hepatectomy in a subset of patients who would otherwise be marginal candidates for resection based on a small liver remnant size.