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Oncological Outcomes of Major Liver Resection Following Portal Vein Embolization: A Systematic Review and Meta-analysis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Preoperative portal vein occlusion with either percutaneous portal vein embolization (PVE) or portal vein ligation is routinely used to induce liver hypertrophy prior to major liver resection in patients with hepatic malignancy. While this increases the future liver remnant, and hence the number of patients suitable for resection, recent evidence suggests that induction of liver hypertrophy preoperatively may promote tumor growth and increase recurrence rates. The aims of this current study were to evaluate the impact of PVE on hepatic recurrence rate and survival in patients with colorectal liver metastases (CRLM).

Methods

The MEDLINE, EMBASE and Web of Science databases were searched to identify studies assessing the oncological outcomes of patients undergoing major liver resection for CRLM following PVE. Studies comparing patients undergoing one-stage liver resection with or without preoperative PVE were included. The primary outcome was postoperative hepatic recurrence (PHR), while secondary outcomes were 3- and 5-year overall survival (OS).

Results

Of the 2131 studies identified, six non-randomized studies (n = 668) met the eligibility criteria, comparing outcomes of patients undergoing major liver resection with or without PVE (n = 182 and n = 486, respectively). No significant difference was observed in PHR (odds ratio [OR] 0.78; 95 % confidence interval [CI] 0.42–1.44), 3-year OS (OR 0.80; 95 % CI 0.56–1.14) or 5-year OS (OR 1.12; 95 % CI 0.40–3.11).

Conclusions

PVE does not have any adverse effect on PHR or OS in patients undergoing major liver resection for CRLM. Further studies based on individual patient data are needed to provide definitive answers.

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Authors and Affiliations

  1. Hepatopancreatobiliary Surgical Unit, Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London, UK

    Mariano Cesare Giglio MD, Alexandros Giakoustidis PhD, Ahmed Draz MD, Zaynab A. R. Jawad MSc, MRCS, Madhava Pai MSc, FRCS, Nagy A. Habib ChM, FRCS, Paul Tait MA, FRCR, Adam E. Frampton PhD, MRCS & Long R. Jiao MD, FRCS

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  1. Mariano Cesare Giglio MD
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Correspondence to Long R. Jiao MD, FRCS.

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Mariano Cesare Giglio, Alexandros Giakoustidis, Ahmed Draz, Zaynab A. R. Jawad, Madhava Pai, Nagy A. Habib, Paul Tait, Adam E. Frampton and Long R. Jiao declare that there are no financial interests or financial conflict to disclose with regard to the subject matter or materials discussed in this paper.

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10434_2016_5264_MOESM3_ESM.eps

Funnel plot of all studies included in the meta-analysis. The standard error (SE) of the log odds ratio (OR) was plotted against the OR for post-operative hepatic recurrence (PHR). Supplementary material 3 (EPS 350 kb)

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Giglio, M.C., Giakoustidis, A., Draz, A. et al. Oncological Outcomes of Major Liver Resection Following Portal Vein Embolization: A Systematic Review and Meta-analysis. Ann Surg Oncol 23, 3709–3717 (2016). https://doi.org/10.1245/s10434-016-5264-6

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  • DOI: https://doi.org/10.1245/s10434-016-5264-6

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