Combined portal and hepatic vein embolization produces greater hypertrophy than portal vein embolization alone with similar post-hepatectomy outcomes and is not impacted by hepatic artery infusion chemotherapy Journal Article
| Authors: | Choubey, A. P.; Chou, J. F.; Soares, K. C.; Wei, A. C.; D’Angelica, M. I.; Jarnagin, W. R.; Gonen, M.; Balachandran, V. P.; Drebin, J.; Santos, E.; Camacho, J. C.; Kingham, T. P.; Ridouani, F. |
| Article Title: | Combined portal and hepatic vein embolization produces greater hypertrophy than portal vein embolization alone with similar post-hepatectomy outcomes and is not impacted by hepatic artery infusion chemotherapy |
| Abstract: | Background: Combined portal and hepatic vein embolization (cPVE-HVE) induces hypertrophy of future liver remnant before hepatectomy. We compared liver hypertrophy and post-hepatectomy outcomes between cPVE-HVE and portal vein embolization (PVE) alone. Patients and Methods: Consecutive patient outcomes after cPVE-HVE and PVE were compared across all pathologies for degree of hypertrophy (DH), kinetic growth rate (KGR), impact of hepatic artery infusion chemotherapy (HAIC), and post-hepatectomy complications at a single center. Results: The study cohort included 305 patients, 250 underwent PVE and 55 underwent cPVE-HVE. Pre-embolization future liver remnant (FLR) was 28% versus 32% (p < 0.001) for cPVE-HVE and PVE. Post-embolization DH (11.3% versus 9.4%; p = 0.001) and KGR (3.33% versus 2.29%; p < 0.001) were significantly greater for cPVE-HVE over shorter interval (22 versus 28 days; p = 0.007). HAIC was used in 42% (n = 23) of patients before cPVE-HVE and did not impact hypertrophy. Post-hepatectomy outcomes were similar between cPVE-HVE (n = 38) and PVE (n = 250) cohorts. Rates of transfusion (39% versus 40%; p > 0.9), liver failure (7.9% versus 9.2%, p = 0.6), grade 3–5 complications (42% versus 42%, p > 0.9), 90 day all-cause mortality (5.3% versus 3.6%, p = 0.6), and median hospitalization (7 versus 8 days; p = 0.067) were not significantly different. Conclusions: cPVE-HVE was associated with greater hypertrophy than PVE alone, with similar post-hepatectomy outcomes. cPVE-HVE after HAIC was safe with similar hypertrophy. Randomized clinical trial evidence is needed to clearly delineate indication for cPVE-HVE and assess postoperative outcomes. © Society of Surgical Oncology 2025. |
| Keywords: | portal vein embolization; hepatic artery infusion pump; hepatic artery infusion chemotherapy; kinetic growth rate; post-hepatectomy liver failure; combined portal vein embolization and hepatic vein embolization; degree of hypertrophy |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 32 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Publication status: | Published |
| Date Published: | 2025-08-01 |
| Start Page: | 5675 |
| End Page: | 5683 |
| Language: | English |
| DOI: | 10.1245/s10434-025-17287-9 |
| PROVIDER: | scopus |
| PUBMED: | 40304945 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is T. Peter Kingham -- Source: Scopus |
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