Institute of Physiology, University of Zurich, Zurich, Switzerland.
Department of General, Visceral and Transplant Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
Br J Surg. 2021 Jul 23;108(7):834-842. doi: 10.1093/bjs/znaa149.
The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability.
All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis.
In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders.
PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.
肝脏切除术的范围受到未来肝残存量（FRL）预期功能储备的限制，因此门静脉栓塞术（PVE）可能会诱导肝组织增生，需要 6 周或更长时间才能生长。本研究评估了同时栓塞门静脉和肝静脉（PVE/HVE）是否可以加速肝组织增生并提高可切除性的假说。
要求 DRAGON 试验研究协作组的所有中心提供 2016 年至 2019 年期间接受 PVE/HVE 或 PVE 治疗的患者数据（需要超过 5 次 PVE/HVE 操作）。使用 OsiriX MD 软件进行肝脏体积测量。使用接收器工作特征（ROC）统计、回归和 Kaplan-Meier 分析对可切除性率、FLR 增生和主要并发症的终点进行多变量分析。
共有 39 名患者接受了 PVE/HVE，160 名患者接受了 PVE 治疗。与 PVE 组相比，PVE/HVE 组的增生更好（分别为 59%和 48%；P=0.020），可切除性也更好（分别为 90%和 68%；P=0.007）。主要并发症（分别为 26%和 34%；P=0.550）和 90 天死亡率（分别为 3%和 16%，P=0.065）相似。多变量分析证实，这些效果独立于混杂因素。
在本协作经验中，与 PVE 相比，PVE/HVE 可实现更好的 FLR 增生和可切除性。
