Portal vein embolization versus dual vein embolization for management of the future liver remnant in patients undergoing major hepatectomy: meta-analysis

Abstract

Background This meta-analysis aimed to compare progression to surgery, extent of liver hypertrophy, and postoperative outcomes in patients planned for major hepatectomy following either portal vein embolization (PVE) or dual vein embolization (DVE) for management of an inadequate future liver remnant (FLR). Methods An electronic search was performed of MEDLINE, Embase, and PubMed databases using both medical subject headings (MeSH) and truncated word searches. Articles comparing PVE with DVE up to January 2022 were included. Articles comparing sequential DVE were excluded. ORs, risk ratios, and mean difference (MD) were calculated using fixed and random-effects models for meta-analysis. Results Eight retrospective studies including 523 patients were included in the study. Baseline characteristics between the groups, specifically, age, sex, BMI, indication for resection, and baseline FLR (ml and per cent) were comparable. The percentage increase in hypertrophy was larger in the DVE group, 66 per cent in the DVE group versus 27 per cent in the PVE group, MD 39.07 (9.09, 69.05) (P = 0.010). Significantly fewer patients failed to progress to surgery in the DVE group than the PVE group, 13 per cent versus 25 per cent respectively OR 0.53 (0.31, 0.90) (P = 0.020). Rates of post-hepatectomy liver failure 13 per cent versus 22 per cent (P = 0.130) and major complications 20 per cent versus 28 per cent (Clavien–Dindo more than IIIa) (P = 0.280) were lower. Perioperative mortality was lower with DVE, 1 per cent versus 10 per cent (P = 0.010) Conclusion DVE seems to produce a greater degree of hypertrophy of the FLR than PVE alone which translates into more patients progressing to surgery. Higher quality studies are needed to confirm these results.

Liver regeneration after portal and hepatic vein embolization improves overall survival compared with portal vein embolization alone: mid-term survival analysis of the multicentre DRAGON 0 cohort

“…The recent retrospective observational DRAGON 0 study demonstrated a substantially increased resection rate, comparable to that of ALPPS, after PVE/HVE, with a safety profile similar to that of PVE alone 17 . These findings were confirmed in a meta-analysis of all published comparative studies comparing PVE/HVE versus PVE alone, and fit well in the contemporary development of minimization of the physical impact of oncological treatments 18 , 19 . It has not yet been determined whether this also translates into better oncological outcomes.…”

Mini-ALPPS-based multidisciplinary treatment leading to long-term survival in a patient with a large HCC: A case report

“…Sequential or simultaneous TACE and PVE could help control the tumor progression and further facilitate FLR regeneration, but they did not substantially reduce the long waiting period for staged hepatectomy ( 9 ). A combination of PVE and hepatic vein embolization (HVE) significantly shortened the waiting period to 3–4 weeks and tended to be safe and effective ( 10 ). ALPPS induces the most rapid hypertrophy of FLR and confers a higher rate of earlier resection compared with PVE-based treatments above, but it is associated with a high postoperative mortality and complications rate.…”

Volume and flow modulation strategies to mitigate post-hepatectomy liver failure

“…Following liver resection rates of major complications appeared lower as did the incidence of PHLF with DVE, 13% versus 22% (p=0.13) although this did not reach statistical significance. Post-operative mortality was also improved following DVE ( 41 ). Whilst several randomized studies are currently in progress comparing PVE to DVE (DRAGON 1 –Training, Accreditation, Implementation and Safety Evaluation of Combined PVE/HVE – ClinicalTrials.gov NCT04272931 and HYPER-LIV01 the outcomes from retrospective studies, and meta-analysis of these, suggests that DVE is associated with improved hypertrophy and perhaps lower complications, particularly PHLF than PVE alone ( 42 ).…”