1. Effect of structured use of preoperative portal vein embolization on outcomes after liver resection of perihilar cholangiocarcinoma
- Author
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Lotte C. Franken, Marc G. Besselink, K.P. van Lienden, Pim B. Olthof, Fadi Rassam, O.R.C. Busch, T.M. van Gulik, Joris I. Erdmann, Roel J. Bennink, Graduate School, CCA - Cancer Treatment and Quality of Life, AGEM - Endocrinology, metabolism and nutrition, AGEM - Re-generation and cancer of the digestive system, Amsterdam Gastroenterology Endocrinology Metabolism, Radiology and Nuclear Medicine, AGEM - Digestive immunity, Cancer Center Amsterdam, and Surgery
- Subjects
Male ,medicine.medical_specialty ,lcsh:Surgery ,Scintigraphy ,Preoperative care ,Hepatectomy ,Humans ,Medicine ,Perihilar Cholangiocarcinoma ,Aged ,Netherlands ,Retrospective Studies ,Body surface area ,medicine.diagnostic_test ,Portal Vein ,business.industry ,Mortality rate ,Liver Neoplasms ,Retrospective cohort study ,lcsh:RD1-811 ,Original Articles ,General Medicine ,Middle Aged ,Embolization, Therapeutic ,Surgery ,Bile Duct Neoplasms ,HPB ,Portal vein embolization ,Original Article ,Female ,Liver function ,business ,Liver Failure ,Klatskin Tumor - Abstract
Background Portal vein embolization (PVE) is performed to reduce the risk of liver failure and subsequent mortality after major liver resection. Although a cut‐off value of 2·7 per cent per min per m2 has been used with hepatobiliary scintigraphy (HBS) for future remnant liver function (FRLF), patients with perihilar cholangiocarcinoma (PHC) potentially benefit from an additional cut‐off of 8·5 per cent/min (not corrected for body surface area). Since January 2016 a more liberal approach to PVE has been adopted, including this additional cut‐off for HBS of 8·5 per cent/min. The aim of this study was to assess the effect of this approach on liver failure and mortality. Methods This was a single‐centre retrospective study in which consecutive patients undergoing liver resection under suspicion of PHC in 2000–2015 were compared with patients treated in 2016–2019, after implementation of the more liberal approach. Primary outcomes were postoperative liver failure (International Study Group of Liver Surgery grade B/C) and 90‐day mortality. Results Some 191 patients with PHC underwent liver resection. PVE was performed in 6·4 per cent (9 of 141) of the patients treated in 2000–2015 and in 32 per cent (16 of 50) of those treated in 2016–2019. The 90‐day mortality rate decreased from 16·3 per cent (23 of 141) to 2 per cent (1 of 50) (P = 0·009), together with a decrease in the rate of liver failure from 19·9 per cent (28 of 141) to 4 per cent (2 of 50) (P = 0·008). In 2016–2019, 24 patients had a FRLF greater than 8·5 per cent/min and no liver failure or death occurred, suggesting that 8·5 per cent/min is a reliable cut‐off for patients with suspected PHC. Conclusion The major decrease in liver failure and mortality rates in recent years and the simultaneous increased use of PVE suggests an important role for PVE in reducing adverse outcomes after surgery for PHC., The use of portal vein embolization (PVE) in patients undergoing major liver resection for perihilar cholangiocarcinoma at the authors' centre increased from 6·4 per cent in 2000–2015 to 32 per cent in 2016–2019. This increased use of PVE coincided with a major decrease in the postoperative liver failure rate, from 19·9 to 4 per cent, and a decrease in the 90‐day mortality rate, from 16·3 to 2 per cent. Using hepatobiliary scintigraphy, an additional cut‐off for future remnant liver function of 8·5 per cent/min (not corrected for body surface area) correlated with safe liver resection in patients with suspected perihilar cholangiocarcinoma. Portal vein embolization decreases rates of liver failure and mortality
- Published
- 2020