Smits Jens, Chau Steven, James Sinéad, Korenblik Remon, Tschögl Madita, Arntz Pieter, Bednarsch Jan, Abreu de Carvalho Luis, Detry Olivier, Erdmann Joris, Gruenberger Thomas, Hermie Laurens, Neumann Ulf, Sandström Per, Sutcliffe Robert, Denys Alban, Melloul Emmanuel, Dewulf Maxime, van der Leij Christiaan, van Dam Ronald M
Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229, ER, Maastricht, The Netherlands.
Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229, HX, Maastricht, The Netherlands.
HPB (Oxford). 2024 Dec;26(12):1458-1466. doi: 10.1016/j.hpb.2024.07.407. Epub 2024 Jul 16.
Major hepatectomy in perihilar cholangiocarcinoma (pCCA) patients with a small future liver remnant (FLR) risks posthepatectomy liver failure (PHLF). This study examines combined portal and hepatic vein embolisation (PVE/HVE) to increase preoperative FLR volume and potentially decrease PHLF rates.
In this retrospective, multicentre, observational study, data was collected from centres affiliated with the DRAGON Trials Collaborative and the EuroLVD registry. The study included pCCA patients who underwent PVE/HVE between July 2016 and January 2023.
Following PVE/HVE, 28% of patients (9/32) experienced complications, with 22% (7/32) necessitating biliary interventions for cholangitis. The median degree of hypertrophy after a median of 16 days was 16% with a kinetic growth rate of 6.8% per week. 69% of patients (22/32) ultimately underwent surgical resection. Cholangitis after PVE/HVE was associated with unresectability. After resection, 55% of patients (12/22) experienced complications, of which 23% (5/22) were Clavien-Dindo grade III or higher. The 90-day mortality after resection was 0%.
PVE/HVE quickly enhances the kinetic growth rate in pCCA patients. Cholangitis impairs chances on resection significantly. Resection after PVE/HVE is associated with low levels of 90-day mortality. The study highlights the potential of PVE/HVE in improving safety and outcomes in pCCA undergoing resection.
未来肝残余量（FLR）较小的肝门部胆管癌（pCCA）患者进行大范围肝切除术后有发生肝切除术后肝衰竭（PHLF）的风险。本研究探讨联合门静脉和肝静脉栓塞术（PVE/HVE）以增加术前FLR体积，并可能降低PHLF发生率。
在这项回顾性、多中心观察性研究中，收集了DRAGON试验协作组和欧洲肝脏血管疾病登记处附属中心的数据。该研究纳入了2016年7月至2023年1月期间接受PVE/HVE的pCCA患者。
PVE/HVE术后，28%的患者（9/32）出现并发症，其中22%（7/32）因胆管炎需要进行胆道干预。在中位时间为16天后，肥大的中位程度为16%，动力学生长率为每周6.8%。69%的患者（22/32）最终接受了手术切除。PVE/HVE后的胆管炎与不可切除性相关。切除术后，55%的患者（12/22）出现并发症，其中23%（5/22）为Clavien-Dindo III级或更高等级。切除术后90天死亡率为0%。
PVE/HVE可迅速提高pCCA患者的动力学生长率。胆管炎显著降低了切除的机会。PVE/HVE后的切除与90天低死亡率相关。该研究突出了PVE/HVE在改善接受切除术的pCCA患者安全性和预后方面的潜力。
