Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases Journal Article

Authors: Covey, A. M.; Brown, K. T.; Jarnagin, W. R.; Brody, L. A.; Schwartz, L.; Tuorto, S.; Sofocleous, C. T.; D'Angelica, M.; Getrajdman, G. I.; DeMatteo, R.; Kemeny, N. E.; Fong, Y.
Article Title: Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases
Abstract: OBJECTIVES: The objectives of this study are 1) to determine whether the future liver remnant will grow after portal vein embolization (PVE) in patients with colon cancer on concurrent chemotherapy and 2) to determine whether recovery after extended hepatectomy is improved after PVE. PURPOSE: Neoadjuvant chemotherapy followed by hepatic resection is an increasingly used therapeutic strategy for curative treatment for colorectal metastases. However, such chemotherapy may result in steatosis, liver damage, and compromised liver regeneration and recovery. This study aims to determine whether PVE can be used during neoadjuvant therapy to enhance growth of future residual liver and to improve postoperative recovery. METHODS: From September 1999 to September 2004, 100 patients with colorectal metastases to the liver were subjected to PVE as preparation for extended hepatic resection, 43 of whom were embolized during neoadjuvant chemotherapy. Liver growth was examined by computed tomography volumetric analysis. Clinical outcomes of the 71 patients subsequently resected were compared with 100 consecutive patients subjected to extended resection without PVE (controls). RESULTS: After a median wait of 30 +/- 2 days after PVE, patients on neoadjuvant chemotherapy experienced a median contralateral (nonembolized) liver growth of 22% +/- 3% compared with 26% +/- 3% for those without chemotherapy (P = NS). The number of patients with <5% growth was also similar: 4 of 43 versus 6 of 57 (P = NS). Comparison of patients resected after PVE to a simultaneous cohort of 100 consecutive patients subjected to extended resection without prior PVE demonstrated a lower fresh frozen plasma requirement (P = 0.01), a lower peak bilirubin (P = 0.002), and a shorter length of stay (P = 0.03). Mortality was similar (0% vs. 2%). CONCLUSIONS: Liver growth occurs after PVE even when cytotoxic chemotherapy is administered. No major complications occurred with PVE. Patients requiring major hepatic resection should be considered for PVE during neoadjuvant chemotherapy to improve subsequent recovery after resection.
Keywords: adult; aged; aged, 80 and over; middle aged; artificial embolism; liver neoplasms; adjuvant therapy; comparative study; neoadjuvant therapy; metastasis; pathology; colorectal neoplasms; colorectal tumor; liver tumor; liver resection; hepatectomy; liver regeneration; portal vein; embolization, therapeutic
Journal Title: Annals of Surgery
Volume: 247
Issue: 3
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2008-03-01
Start Page: 451
End Page: 455
Language: English
PUBMED: 18376189
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 37" - "Export Date: 17 November 2011" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Ronald P DeMatteo
    627 DeMatteo
  2. Lawrence H Schwartz
    282 Schwartz
  3. Anne Covey
    136 Covey
  4. William R Jarnagin
    654 Jarnagin
  5. Yuman Fong
    772 Fong
  6. Lynn Brody
    100 Brody
  7. Karen T Brown
    172 Brown
  8. Scott J Tuorto
    23 Tuorto
  9. Nancy Kemeny
    438 Kemeny