TY - JOUR
T1 - Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma
AU - Olthof, Pim B.
AU - Aldrighetti, Luca
AU - Alikhanov, Ruslan
AU - Cescon, Matteo
AU - Groot Koerkamp, Bas
AU - Jarnagin, William R.
AU - Nadalin, Silvio
AU - Pratschke, Johann
AU - Schmelze, Moritz
AU - Sparrelid, Ernesto
AU - Lang, Hauke
AU - Guglielmi, Alfredo
AU - van Gulik, Thomas M.
AU - the Perihilar Cholangiocarcinoma Collaboration Group
AU - Andreou, A.
AU - Bartsch, F.
AU - Benzing, C.
AU - Buettner, S.
AU - Capobianco, I.
AU - de Reuver, P.
AU - de Savornin Lohman, E.
AU - Dejong, C. H. C.
AU - Efanov, M.
AU - Erdmann, J. I.
AU - Franken, L. C.
AU - Frascaroli, G.
AU - Giglio, M. C.
AU - Gomez-Gavara, C.
AU - Heid, F.
AU - IJzermans, J. N. M.
AU - Jansson, H.
AU - Ligthart, M. A. P.
AU - Maithel, S. K.
AU - Malago, M.
AU - Malik, H. Z.
AU - Muiesan, P.
AU - Olde Damink, S. W. M.
AU - Pando, E.
AU - Quinn, L. M.
AU - Ratti, F.
AU - Roberts, K. J.
AU - Rolinger, J.
AU - Ruzzenente, A.
AU - Schadde, E.
AU - Serenari, M.
AU - Sultana, A.
AU - Troisi, R.
AU - van Laarhoven, S.
AU - van Vugt, J. L. A.
N1 - Funding Information: The following members of the Perihilar Cholangiocarcinoma collaboration group: A. Andreou, F. Bartsch, C. Benzing, S. Buettner, I. Capobianco, P. de Reuver, E. de Savornin Lohman, C. H. C. Dejong, M. Efanov, J. I. Erdmann, L. C. Franken, G. Frascaroli, M. C. Giglio, C. Gomez-Gavara, F. Heid, J. N. M. IJzermans, H. Jansson, M. A. P. Ligthart, S. K. Maithel, M. Malago, H. Z. Malik, P. Muiesan, S. W. M. Olde Damink, E. Pando, L. M. Quinn, F. Ratti, K. J. Roberts, J. Rolinger, A. Ruzzenente, E. Schadde, M. Serenari, A. Sultana, R. Troisi, S. van Laarhoven, J. L. A. van Vugt. Publisher Copyright: © 2020, The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Background: Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective: This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods: Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results: A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p < 0.001 and p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p < 0.001), as was biliary leakage (10% vs. 35%, p < 0.01), intra-abdominal abscesses (19% vs. 34%, p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion: PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.
AB - Background: Preoperative portal vein embolization (PVE) is frequently used to improve future liver remnant volume (FLRV) and to reduce the risk of liver failure after major liver resection. Objective: This paper aimed to assess postoperative outcomes after PVE and resection for suspected perihilar cholangiocarcinoma (PHC) in an international, multicentric cohort. Methods: Patients undergoing resection for suspected PHC across 20 centers worldwide, from the year 2000, were included. Liver failure, biliary leakage, and hemorrhage were classified according to the respective International Study Group of Liver Surgery criteria. Using propensity scoring, two equal cohorts were generated using matching parameters, i.e. age, sex, American Society of Anesthesiologists classification, jaundice, type of biliary drainage, baseline FLRV, resection type, and portal vein resection. Results: A total of 1667 patients were treated for suspected PHC during the study period. In 298 patients who underwent preoperative PVE, the overall incidence of liver failure and 90-day mortality was 27% and 18%, respectively, as opposed to 14% and 12%, respectively, in patients without PVE (p < 0.001 and p = 0.005). After propensity score matching, 98 patients were enrolled in each cohort, resulting in similar baseline and operative characteristics. Liver failure was lower in the PVE group (8% vs. 36%, p < 0.001), as was biliary leakage (10% vs. 35%, p < 0.01), intra-abdominal abscesses (19% vs. 34%, p = 0.01), and 90-day mortality (7% vs. 18%, p = 0.03). Conclusion: PVE before major liver resection for PHC is associated with a lower incidence of liver failure, biliary leakage, abscess formation, and mortality. These results demonstrate the importance of PVE as an integral component in the surgical treatment of PHC.
UR - http://www.scopus.com/inward/record.url?scp=85080025389&partnerID=8YFLogxK
U2 - https://doi.org/10.1245/s10434-020-08258-3
DO - https://doi.org/10.1245/s10434-020-08258-3
M3 - Article
C2 - 32103419
SN - 1068-9265
VL - 27
SP - 2311
EP - 2318
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 7
ER -