Oncological Outcomes after Liver Venous Deprivation for Colorectal Liver Metastases: A Single Center Experience

Abstract

Colorectal liver metastases (CRLM) are the major cause of death in patients with colorectal cancer (CRC). The cornerstone treatment of CRLM is surgical resection. Post-operative morbidity and mortality are mainly linked to an inadequate future liver remnant (FLR). Nowadays preoperative portal vein embolization (PVE) is the most widely performed technique to increase the size of the future liver remnant (FLR) before major hepatectomies. One method recently proposed to increase the FLR is liver venous deprivation (LVD), but its oncological impact is still unknown. The aim of this study is to report first short- and long-term oncological outcomes after LVD in patients undergoing right (or extended right) hepatectomy for CRLM. Seventeen consecutive patients undergoing LVD between July 2015 and May 2020 before an (extended) right hepatectomy were retrospectively analyzed from an institutional database. Post-operative and follow-up data were analyzed and reported. Primary outcomes were 1-year and 3-year overall survival (OS) and hepatic recurrence (HR). Postoperative complications occurred in 8 patients (47%). No deaths occurred after surgery. HR occurred in 9 patients (52.9%). 1-year and 3-year OS were 87% (95% confidence interval [CI]: ±16%) and 60.3%, respectively (95% CI: ±23%). Median Disease-Free Survival (DFS) was 6 months (CI 95%: 4.7–7.2). With all the limitations of a retrospective study with a small sample size, LVD showed similar oncological outcomes compared to literature reports for Portal Vein Embolization (PVE).

Liver Venous Deprivation Versus Portal Vein Embolization Before Major Hepatectomy for Colorectal Liver Metastases: A Retrospective Comparison of Short- and Medium-Term Outcomes

“…Similarly, the preliminary oncological outcomes of LVD in CRLM patients appear to be encouraging, as recently suggested in other studies. 35 , 36 Previous studies have hypothesized negative effects on tumor growth following liver volume augmentation procedures, including PVE. 37 However, a recent meta-analysis by Giglio et al concluded that PVE did not adversely affect cancer outcomes after major hepatectomy in patients with CRLM.…”

Portal Vein Embolization: Rationale, Techniques, and Outcomes to Maximize Remnant Liver Hypertrophy with a Focus on Contemporary Strategies

“…A subject of debate surrounding LVD, like that in PVE, is that of oncological outcomes of the procedure. Khayat et al retrospectively reviewed 17 patients and reported on their 1-year OS, their 3-year OS, and median DFS [ 76 ]. They found that the 1-year and 3-year OS post-LVD was 87% and 60.3% respectively, and the median DFS was 6 months.…”

Imaging-guided interventions modulating portal venous flow: Evidence and controversies

“…In this setting, embolisation of both the right and middle hepatic veins or just the middle hepatic vein could be considered in association with PVE. 143 , 144 Despite promising results, the results of RCTs are awaited to compare the 2 approaches and the added value of combined embolisation on patient outcome must be evaluated in large cohorts. 145 In particular, this interventional procedure should also be compared to ALPPS for 2-stage hepatectomy because it could decrease morbidity but achieve similar hypertrophy.…”