Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma
Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma
Background: 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.
Methods: 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.
Results: 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%.
Conclusion: 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.
Smits, Jens
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Chau, Steven
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James, Sinéad
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Korenblik, Remon
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Tschögl, Madita
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Arntz, Pieter
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Bednarsch, Jan
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Abreu de Carvalho, Luis
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Detry, Olivier
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Erdmann, Joris
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Gruenberger, Thomas
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Hermie, Laurens
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Neumann, Ulf
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Sandström, Per
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Sutcliffe, Robert
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Denys, Alban
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Melloul, Emmanuel
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Dewulf, Maxime
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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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EuroLVD and DRAGON Trials Collaborative
Smits, Jens
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Chau, Steven
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James, Sinéad
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Korenblik, Remon
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Tschögl, Madita
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Arntz, Pieter
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Bednarsch, Jan
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Abreu de Carvalho, Luis
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Detry, Olivier
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Erdmann, Joris
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Gruenberger, Thomas
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Hermie, Laurens
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Neumann, Ulf
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Sandström, Per
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Sutcliffe, Robert
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Denys, Alban
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Melloul, Emmanuel
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Dewulf, Maxime
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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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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 and van Dam, Ronald M.
,
EuroLVD and DRAGON Trials Collaborative
(2024)
Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma.
HPB.
(doi:10.1016/j.hpb.2024.07.407).
Abstract
Background: 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.
Methods: 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.
Results: 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%.
Conclusion: 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.
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PIIS1365182X24022196
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Accepted/In Press date: 11 July 2024
e-pub ahead of print date: 16 July 2024
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© 2024 The Authors
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Local EPrints ID: 495986
URI: http://eprints.soton.ac.uk/id/eprint/495986
ISSN: 1365-182X
PURE UUID: 8133d53f-efb9-4ffa-8763-4ca222dbac53
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Date deposited: 28 Nov 2024 17:46
Last modified: 30 Nov 2024 02:35
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Contributors
Author:
Jens Smits
Author:
Steven Chau
Author:
Sinéad James
Author:
Remon Korenblik
Author:
Madita Tschögl
Author:
Pieter Arntz
Author:
Jan Bednarsch
Author:
Luis Abreu de Carvalho
Author:
Olivier Detry
Author:
Joris Erdmann
Author:
Thomas Gruenberger
Author:
Laurens Hermie
Author:
Ulf Neumann
Author:
Per Sandström
Author:
Robert Sutcliffe
Author:
Alban Denys
Author:
Emmanuel Melloul
Author:
Maxime Dewulf
Author:
Christiaan van der Leij
Author:
Ronald M. van Dam
Corporate Author: EuroLVD and DRAGON Trials Collaborative
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