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.; Ratti, F.

doi:10.1016/j.hpb.2024.07.407

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.; Ratti, F.. - In: HPB. - ISSN 1365-182X. - 26:12(2024), pp. 1458-1466. [10.1016/j.hpb.2024.07.407]