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.
Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma / Smits, J.; Chau, S.; James, S.; Korenblik, R.; Tschogl, M.; Arntz, P.; Bednarsch, J.; Abreu de Carvalho, L.; Detry, O.; Erdmann, J.; Gruenberger, T.; Hermie, L.; Neumann, U.; Sandstrom, P.; Sutcliffe, R.; Denys, A.; Melloul, E.; Dewulf, M.; van der Leij, C.; van Dam, R. M.; Chevallier, P.; Wigmore, S.; Newhook, T.; Vauthey, J. -N.; Memeo, R.; Dasari, B. V.; Braunwarth, E.; Aldrighetti, L.; Andorra, E. C.; Arslan, B.; van Baardewijk, L.; Baclija, I.; Ball, C.; Barbier, L.; Bemelmans, M.; Bent, C.; van den Bergh, F.; Billingsley, K.; Binkert, C.; Bjornsson, B.; de Boer, M. T.; Bokkers, R. P. H.; de Boo, D.; Garcia Borobia, F. J.; Braat, D.; Breen, D.; Breitenstein, S.; Brousseau, K.; Bruijnen, R.; Bruners, P.; Bruns, C.; Bunck, A.; Burgmans, M.; Cappelli, A.; Carling, U.; de Carvalho, L. A.; Cha, C.; Chan, B.; Chand, B.; Chapelle, T.; De Cobelli, F.; Coubeau, L.; Criado, E.; Croagh, D.; D'Hondt, M.; van Dam, R.; Damink, S. O.; Davis, R.; Delle, M.; Deprez, F.; Dili, A.; Dixon, M.; Diaz-Nieto, R.; Erdmann, J. I.; Fernando, R.; Font, J. C.; Fouraschen, S.; Francois, O.; Fretland, A. A.; Fundora, Y.; Gadani, S.; Gallinger, S.; Geleabert, A.; Gerard, L.; Gimenez, J. G.; Gobardhan, P.; Goffette, P.; Grochola, L. F.; Grunhagen, D.; Guiliante, F.; Gomez, F.; Hagendoorn, J.; Hammond, J.; Heijmans, M.; Heil, J.; Heise, D.; Laurens, Hermie; Herrero, E.; Hess, G.; Heye, S.; Hoffmann, M.; Iezzi, R.; Imani, F.; James, S.; Jardinet, T.; Joshi, K.; Jovine, E.; Kalil, J.; Karanicolas, P.; Kazemier, G.; Kern, L.; Kingham, P.; Klass, D.; Koerkamp, B. G.; Kollmar, O.; Choon, Kwon; Celine, Lambrecht; Sven, Lang; Laura-Ann, ; Leclercq, W.; Lindsay, R.; Lopez-Ben, S.; Lucidi, V.; Lopez, J. N.; Macdonald, A.; Madoff, D. C.; Markose, G.; Maroune, G.; Martel, G.; Martin, E. S.; Mehrzad, H.; Meijerink, M.; Messaoudi, N.; Metrakos, P.; Modi, S.; Montanari, N.; Moragues, J. S.; Mujoomdar, A.; Oor, J.; Pappas, P.; Pieterman, K.; Primrose, J.; Qu, X.; Ratti, F.; Ridouani, F.; Borel Rinkes, I. H. M.; Casellas i Robert, M.; Ross, S.; Ruo, L.; Ryan, S.; Salik, A.; Santol, J.; Sarria, L.; Schaarschmidt, B.; Schadde, E.; Schiesser, M.; Schmelzle, M.; Seeger, N.; Segedi, M.; Serenari, M.; Gregory, Sergeant; Serrablo, A.; Simon, S.; Skaro, A.; Smits, M.; Snitzbauer, A.; Soonawalla, Z.; Sparrelid, E.; Spuentrup, E.; Stavrou, G.; Swijnenburg, R. -J.; Tancredi, I.; Tasse, J. C.; Udupa, V.; Valenti, D. A.; Vass, D.; van der Velden, A. L.; Vogl, T.; Wacker, F.; Wang, X.; Weitz, J.; White, S.; Widyaningsih, R.; De Wispelaere, J. -F.; Zijlstra, I.. - In: HPB. - ISSN 1365-182X. - 26:12(2024), pp. 1458-1466. [10.1016/j.hpb.2024.07.407]
Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma
Aldrighetti L.;De Cobelli F.;Ratti F.;
2024-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
