Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis
Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis
Background: many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone.
Methods: systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase.
Results: eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients).
Conclusion: based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.
Hepatic Veins, Humans, Hypertrophy, Liver Neoplasms/surgery, Portal Vein/surgery, Retrospective Studies
Korenblik, Remon
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van Zon, Jasper F.J.A
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Olij, Bram
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Heil, Jan
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Dewulf, Maxime J L
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Neumann, Ulf P
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Olde Damink, Steven W M
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Binkert, Christoph A
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Schadde, Erik
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van der Leij, Christiaan
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van Dam, Ronald M
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Primrose, John
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DRAGON Trials Collaborative
1 December 2022
Korenblik, Remon
22cc9b03-e59c-48a8-9408-44edbc809855
van Zon, Jasper F.J.A
d875977b-56cb-4968-92eb-52d210fc8a77
Olij, Bram
7addf0b3-df3a-44d0-8e15-bb5105fb20ec
Heil, Jan
5061eea0-81fd-435e-8ade-353e1eceeb67
Dewulf, Maxime J L
01c88690-d86d-4f93-8dc5-00cd30f12281
Neumann, Ulf P
cb306c3e-1326-4b16-8628-753795be9f17
Olde Damink, Steven W M
504fcca4-2739-494f-a203-70f0d756d3f7
Binkert, Christoph A
2d390dcf-5a87-4e17-bd29-e0d4f4a7f3a1
Schadde, Erik
2734f9e8-92ce-4011-95d2-6014835503e6
van der Leij, Christiaan
c5c50271-ed4c-4110-ba76-8d61efa0f531
van Dam, Ronald M
7523218d-f43b-4c5c-9117-b4e22649eab3
Primrose, John
d85f3b28-24c6-475f-955b-ec457a3f9185
Korenblik, Remon, van Zon, Jasper F.J.A, Olij, Bram and Primrose, John
,
DRAGON Trials Collaborative
(2022)
Resectability of bilobar liver tumours after simultaneous portal and hepatic vein embolization versus portal vein embolization alone: meta-analysis.
BJS Open, 6 (6), [zrac141].
(doi:10.1093/bjsopen/zrac141).
Abstract
Background: many patients with bi-lobar liver tumours are not eligible for liver resection due to an insufficient future liver remnant (FLR). To reduce the risk of posthepatectomy liver failure and the primary cause of death, regenerative procedures intent to increase the FLR before surgery. The aim of this systematic review is to provide an overview of the available literature and outcomes on the effectiveness of simultaneous portal and hepatic vein embolization (PVE/HVE) versus portal vein embolization (PVE) alone.
Methods: systematic literature search was conducted in PubMed, Web of Science, and Embase up to September 2022. The primary outcome was resectability and the secondary outcome was the FLR volume increase.
Results: eight studies comparing PVE/HVE with PVE and six retrospective PVE/HVE case series were included. Pooled resectability within the comparative studies was 75 per cent in the PVE group (n = 252) versus 87 per cent in the PVE/HVE group (n = 166, OR 1.92 (95% c.i., 1.13-3.25)) favouring PVE/HVE (P = 0.015). After PVE, FLR hypertrophy between 12 per cent and 48 per cent (after a median of 21-30 days) was observed, whereas growth between 36 per cent and 67 per cent was reported after PVE/HVE (after a median of 17-31 days). In the comparative studies, 90-day primary cause of death was similar between groups (2.5 per cent after PVE versus 2.2 per cent after PVE/HVE), but a higher 90-day primary cause of death was reported in single-arm PVE/HVE cohort studies (6.9 per cent, 12 of 175 patients).
Conclusion: based on moderate/weak evidence, PVE/HVE seems to increase resectability of bi-lobar liver tumours with a comparable safety profile. Additionally, PVE/HVE resulted in faster and more pronounced hypertrophy compared with PVE alone.
Text
zrac141
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More information
Accepted/In Press date: 5 October 2022
e-pub ahead of print date: 24 November 2022
Published date: 1 December 2022
Additional Information:
Funding Information:
Funding The DRAGON Trials Collaborative received unrestricted financial support from the Dutch Cancer Foundation, National Institute for Health and Care Research (UK), Abbott Laboratories, Maastricht University Medical Center+, and Guerbet.
Keywords:
Hepatic Veins, Humans, Hypertrophy, Liver Neoplasms/surgery, Portal Vein/surgery, Retrospective Studies
Identifiers
Local EPrints ID: 473549
URI: http://eprints.soton.ac.uk/id/eprint/473549
ISSN: 2474-9842
PURE UUID: d9c72fa4-47d8-4d40-b97d-1fd308cc88be
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Date deposited: 23 Jan 2023 17:45
Last modified: 17 Mar 2024 02:40
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Contributors
Author:
Remon Korenblik
Author:
Jasper F.J.A van Zon
Author:
Bram Olij
Author:
Jan Heil
Author:
Maxime J L Dewulf
Author:
Ulf P Neumann
Author:
Steven W M Olde Damink
Author:
Christoph A Binkert
Author:
Erik Schadde
Author:
Christiaan van der Leij
Author:
Ronald M van Dam
Corporate Author: DRAGON Trials Collaborative
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