Background: Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective: This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods: Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results: A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p < 0.001 and p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p < 0.001), as was biliary leakage (10% vs. 35%, p < 0.01), intra-abdominal abscesses (19% vs. 34%, p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion: PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.

Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma / P.B. Olthof, L. Aldrighetti, R. Alikhanov, M. Cescon, B. Groot Koerkamp, W.R. Jarnagin, S. Nadalin, J. Pratschke, M. Schmelze, E. Sparrelid, H. Lang, A. Guglielmi, T.M. van Gulik, A. Andreou, F. Bartsch, C. Benzing, S. Buettner, I. Capobianco, P. de Reuver, E. de Savornin Lohman, C.H.C. Dejong, M. Efanov, J.I. Erdmann, L.C. Franken, G. Frascaroli, M.C. Giglio, C. Gomez-Gavara, F. Heid, J.N.M. IJzermans, H. Jansson, M.A.P. Ligthart, S.K. Maithel, M. Malago, H.Z. Malik, P. Muiesan, S.W.M. Olde Damink, E. Pando, L.M. Quinn, F. Ratti, K.J. Roberts, J. Rolinger, A. Ruzzenente, E. Schadde, M. Serenari, A. Sultana, R. Troisi, S. van Laarhoven, J.L.A. van Vugt. - In: ANNALS OF SURGICAL ONCOLOGY. - ISSN 1068-9265. - 27:7(2020), pp. 2311-2318. [10.1245/s10434-020-08258-3]

Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

P. Muiesan;
2020

Abstract

Background: Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective: This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods: Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results: A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p < 0.001 and p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p < 0.001), as was biliary leakage (10% vs. 35%, p < 0.01), intra-abdominal abscesses (19% vs. 34%, p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion: PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.
Aged; Hepatectomy; Humans; Male; Middle Aged; Preoperative Care; Retrospective Studies; Bile Duct Neoplasms; Embolization, Therapeutic; Klatskin Tumor; Liver Failure; Liver Neoplasms; Portal Vein
Settore MED/18 - Chirurgia Generale
Article (author)
File in questo prodotto:
File Dimensione Formato  
2020-PortalVeinEmbolizationIsAssoci.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 303.83 kB
Formato Adobe PDF
303.83 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/883302
Citazioni
  • ???jsp.display-item.citation.pmc??? 12
  • Scopus 19
  • ???jsp.display-item.citation.isi??? 20
social impact