Sequential intra-arterial therapy and portal vein embolization is feasible and safe in patients with advanced hepatic malignancies

Peter D. Peng, Omar Hyder, Mark Bloomston, Hugo Marques, Celia Corona-Villalobos, Elijah Dixon, Carlo Pulitano, Kenzo Hirose, Richard D. Schulick, Eduardo Barroso, Luca Aldrighetti, Michael Choti, Feng Shen, Ihab Kamel, Jean Francois H. Geschwind, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: A major hepatic resection for malignancies requires an adequate post-operative liver reserve. Portal vein embolization (PVE) with intra-arterial therapy (IAT) may increase future liver remnant (FLR) hypertrophy. As such, the feasibility, safety and efficacy of IAT+PVE were investigated. Methods: Between 2000 to 2011, 86 patients with malignancy of the liver were identified from a multi-institutional database. Twenty-nine patients underwent sequential IAT+PVE, 25 had PVE alone and 32 had IAT alone. Clinicopathological data were evaluated. Results: Most patients had hepatocellular carcinoma (HCC) (65.1%) and 31.4% had secondary metastatic disease. A complete or partial response using European Association for the Study of the Liver (EASLD) criteria was seen in 48.3% of patients undergoing IAT+PVE vs. 56.6% among patients undergoing IAT (P = 0.601). The median increase in percentage FLR volume was comparable in IAT+PVE (7.4%) vs. PVE only (7.9%) (P = 0.203). There were no IAT+PVE-associated deaths and only one complication. Among patients treated with IAT+PVE (n = 29), 27 underwent a subsequent hepatic resection. Peri-operative morbidity and mortality was 29.6% and 7.4%, respectively. Among the patients with HCC who underwent curative intent surgery after IAT+PVE, the median survival was 59.0 months. Conclusions: Sequential IAT and PVE are feasible and safe. Utilization of IAT+PVE before a resection can lead to long-term survival and should be considered in the treatment of patients with advanced hepatic malignancies.

Original languageEnglish (US)
Pages (from-to)523-531
Number of pages9
JournalHPB
Volume14
Issue number8
DOIs
StatePublished - Aug 2012

Keywords

  • Chemoembolization
  • Liver
  • Malignancy
  • Outcome
  • Portal vein embolization
  • Safety

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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