TITLE

Role of Portal Vein Embolization in Hepatocellular Carcinoma Management and Its Effect on Recurrence: A Case-control Study

AUTHOR(S)
Siriwardana, Rohan; Lo, Chung; Chan, See; Fan, Sheung
PUB. DATE
July 2012
SOURCE
World Journal of Surgery;Jul2012, Vol. 36 Issue 7, p1640
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Liver regeneration that occurs after portal vein embolization (PVE) may have adverse effects on the microscopic tumor foci in the residual liver mass in patients with hepatocellular carcinoma (HCC). Methods: Fifty-four HCC patients with inadequate functional residual liver volume were offered PVE during a seven-year period. Among them, 34 (63%) patients underwent curative resection. They were compared with a matched control group ( n = 102) who underwent surgery without PVE. Postoperative complications, pattern of recurrence, and survival were compared between groups. Results: In the PVE group, a pre-embolization functional residual liver volume of 23% (12-33.5%) improved to 34% (20-54%) ( p = 0.005) at the time of surgery. When the two groups were compared, minor (PVE, 24%; control, 29%; p = 0.651) and major (PVE, 18%; control, 15%; p = 0.784) complications were similar. After a follow-up period of 35 months (standard deviation 25 months), extrahepatic recurrences were detected in 10 PVE patients (29%) and 41 control patients (40%) ( p = 0.310). Intrahepatic recurrences were seen in 10 (29%) and 47 (46%) cases ( p = 0.109) in the PVE and control groups, respectively. In the PVE group, 41% ( n = 14) of the recurrences were detected before one year, compared with 42% ( n = 43) in the control group ( p = 1). Disease-free survival rates at 1, 3, and 5 years were 57, 29, and 26% in the control group and 60, 42, and 42% in the PVE group (log-rank, p = 0.335). On multivariate analysis, PVE was not a factor affecting survival ( p = 0.821). Conclusions: Portal vein embolization increases the resectability of initially unresectable HCC due to inadequate functional residual liver volume, and it has no deleterious oncological effect after major resection of HCC.
ACCESSION #
76350202

 

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