Choubey Ankur P, Chou Joanne F, Soares Kevin C, Wei Alice C, D'Angelica Michael I, Jarnagin William R, Gonen Mithat, Balachandran Vinod P, Drebin Jeffrey, Santos Ernesto, Camacho Juan C, Kingham T Peter, Ridouani Fourat
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2025 Apr 30. doi: 10.1245/s10434-025-17287-9.
Combined portal and hepatic vein embolization (cPVE-HVE) induces hypertrophy of future liver remnant before hepatectomy. We compared liver hypertrophy and post-hepatectomy outcomes between cPVE-HVE and portal vein embolization (PVE) alone.
Consecutive patient outcomes after cPVE-HVE and PVE were compared across all pathologies for degree of hypertrophy (DH), kinetic growth rate (KGR), impact of hepatic artery infusion chemotherapy (HAIC), and post-hepatectomy complications at a single center.
The study cohort included 305 patients, 250 underwent PVE and 55 underwent cPVE-HVE. Pre-embolization future liver remnant (FLR) was 28% versus 32% (p < 0.001) for cPVE-HVE and PVE. Post-embolization DH (11.3% versus 9.4%; p = 0.001) and KGR (3.33% versus 2.29%; p < 0.001) were significantly greater for cPVE-HVE over shorter interval (22 versus 28 days; p = 0.007). HAIC was used in 42% (n = 23) of patients before cPVE-HVE and did not impact hypertrophy. Post-hepatectomy outcomes were similar between cPVE-HVE (n = 38) and PVE (n = 250) cohorts. Rates of transfusion (39% versus 40%; p > 0.9), liver failure (7.9% versus 9.2%, p = 0.6), grade 3-5 complications (42% versus 42%, p > 0.9), 90 day all-cause mortality (5.3% versus 3.6%, p = 0.6), and median hospitalization (7 versus 8 days; p = 0.067) were not significantly different.
cPVE-HVE was associated with greater hypertrophy than PVE alone, with similar post-hepatectomy outcomes. cPVE-HVE after HAIC was safe with similar hypertrophy. Randomized clinical trial evidence is needed to clearly delineate indication for cPVE-HVE and assess postoperative outcomes.
门静脉联合肝静脉栓塞术（cPVE-HVE）可在肝切除术前诱导未来肝残余体积增大。我们比较了cPVE-HVE与单纯门静脉栓塞术（PVE）在肝体积增大及肝切除术后结局方面的差异。
在单一中心，比较了cPVE-HVE和PVE术后所有病理类型患者的肝体积增大程度（DH）、动态生长率（KGR）、肝动脉灌注化疗（HAIC）的影响以及肝切除术后并发症。
研究队列包括305例患者，其中250例行PVE，55例行cPVE-HVE。cPVE-HVE组和PVE组栓塞术前的未来肝残余体积（FLR）分别为28%和32%（p < 0.001）。cPVE-HVE组栓塞后的DH（11.3%对9.4%；p = 0.001）和KGR（3.33%对2.29%；p < 0.001）在更短时间间隔内（22天对28天；p = 0.007）显著更高。42%（n = 23）的患者在cPVE-HVE术前接受了HAIC，这并未影响肝体积增大。cPVE-HVE组（n = 38）和PVE组（n = 250）肝切除术后的结局相似。输血率（39%对40%；p > 0.9）、肝衰竭发生率（7.9%对9.2%，p = 0.6）、3-5级并发症发生率（42%对42%，p > 0.9）、90天全因死亡率（5.3%对3.6%，p = 0.6）以及中位住院时间（7天对8天；p = 0.067）均无显著差异。
与单纯PVE相比，cPVE-HVE可使肝体积增大更明显，肝切除术后结局相似。HAIC后行cPVE-HVE安全，肝体积增大情况相似。需要随机临床试验证据来明确cPVE-HVE的适应证并评估术后结局。
