Strategies for Resection Using Portal Vein Embolization: Metastatic Liver Cancer

Abstract

The oncological landscape is constantly changing with the development of new curatively intended therapeutic strategies. More and more, liver metastases are amenable to resection following the progress achieved as a result of new oncological concepts (i.e., treat detectable disease with surgery and ablative therapies and treat the remaining nondetectable disease with efficient chemotherapy) as well as improved chemotherapeutic and ablation techniques. One of the major limitations to extending the indications for liver resection is the volume of the future remnant liver (FRL). To overcome these limitations, portal vein embolization (PVE) has played a key role in obtaining preoperative hypertrophy of the FRL and thus has reduced postoperative morbidity and mortality. Interestingly, thermal ablation of multiple bilateral liver metastases makes it difficult to predict the volume of parenchyma scheduled for ablation. Furthermore, prolonged chemotherapy impairs liver parenchyma function, which has a negative impact on liver hypertrophy. In the future, both volumetric and functional assessment of the FRL will be used to determine whether PVE is necessary before hepatectomy in individual patients and new strategies (e.g., PVE used alone or combined with other treatments; timing of PVE may vary) will be based on these principles. This article presents various current strategies for the use of PVE in patients with metastatic liver cancer.

Keywords

Portal vein embolization - liver metastases - combined treatments

• REFERENCES

• 1 Jaeck D, Bachelier P, Guiguet M. et al. Long-term survival following resection of colorectal hepatic metastases. Br J Surg 1997; 84: 977-980
• 2 Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Surgery 1988; 103: 278-288
• 3 Scheele J, Stangl R, Altendorf-Hofmann A. et al. Resection of colorectal metastases. World J Surg 1995; 19: 59-71
• 4 Adam R, Chiche L, Aloia T. et al. Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1452 patients and development of a prognostic model. Ann Surg 2006; 244: 524-535
• 5 Adam R, Delvart V, Pascal G. et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy. Ann Surg 2004; 240: 644-658
• 6 Kinoshita H, Sakai K, Hirohashi K. et al. Preoperative portal vein embolization for hepatocellular carcinoma. World J Surg 1986; 10: 803-808
• 7 Makuuchi M, Le Thai B, Takayashu K. et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990; 107: 521-527
• 8 Roche A, Soyer A, Elias D. et al. Pre-operative portal vein embolisation for hepatic metastases. J Intervent Radiol 1991; 6: 63-67
• 9 Lee KC, Kinoshita H, Hirohashi K. et al. Extension of surgical indications for hepatocellular carcinoma by portal vein embolization. World J Surg 1993; 17: 109-115
• 10 Kawasaki S, Makuuchi M, Kahazu T. et al. Resection for multiple metastatic liver tumors after portal embolization. Surgery 1994; 115: 674-677
• 11 Azoulay D, Raccuia JS, Castaing D, Bismuth H. Right portal vein embolization in preparation for major hepatic resection. J Am Coll Surg 1995; 181: 266-269
• 12 Elias D, Desruennes E, Lasser P. Prolonged intermittent clamping of the portal triad during hepatectomy. Br J Surg 1991; 78: 42-44
• 13 Elias D, Lasser P, Debaene B. et al. Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy. Br J Surg 1995; 82: 1535-1539
• 14 Elias D, De Baere T, Muttillo I. et al. Intraoperative use of radiofrequency treatment allows an increase in the rate of curative liver resection. J Surg Oncol 1998; 67: 190-191
• 15 Wood TF, Rose DM, Chung M. et al. Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol 2000; 7: 593-600
• 16 Elias D, Baton O, Sideris L. et al. Hepatectomy plus intraoperative radiofrequency ablation and chemotherapy to treat technically unresectable multiple colorectal liver metastases. J Surg Oncol 2005; 90(1): 36-42
• 17 Elias D, Manganas D, Benizri E. et al. The trans-metastasis hepatectomy (through metastases previously ablated with radiofrequency): results of a 13-case study of colorectal cancer. J Surg Oncol 2006; 93: 8-12
• 18 Elias D, Pocard M, Sideris L. et al. Intraductal cooling of the main hepatic ducts during radiofrequency ablation prevents biliary stenosis. J Am Coll Surg 2004; 198: 717-721
• 19 Elias D, Ouellet JF, Baudin E. Resection and radiofrequency ablation of 42 neuroendocrine liver metastases in a single patient. Int J Surg Investig 2002; 3: 453-456
• 20 Diaz Rubio E, Taberno J, Van Custen E. et al. Cetuximab in combination with oxaliplatin-5-fluorouracil in first-line treatment of patients EGFR-expressing metastatic colorectal cancer. Proc Am Soc Clin Oncol 2005; 254(suppl): 1-1 Abstract 3535
• 21 Adam R, Lucidi V, Bismuth H. Hepatic colorectal metastases: methods of improving resectability. Surg Clin North Am 2004; 84: 659-671
• 22 Rubbia-Brandt L, Audard V, Sartoretti P. et al. Severe hepatic sinusoidal obstruction associated with oxaliplatin based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 2004; 15: 460-466
• 23 Vauthey JN, Pawlik TM, Ribero D. et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol 2006; 24: 2065-2072
• 24 Karoui M, Penna C, Amin-Hashem M. et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 2006; 243: 1-7
• 25 Henderson JM, Heymsfield SB, Horowitz J. et al. Measurement of liver and spleen volume by computed tomography. Radiology 1981; 141: 525-527
• 26 Elias D, de Baere T, Roche A. et al. Preoperative selective portal vein embolizations are an effective means of extending the indications of major hepatectomy in normal and injured liver. Hepatogastroenterology 1998; 45: 170-177
• 27 Didolkar MS, Fitzpatrick JL, Elias EG. et al. Risk factors before hepatectomy, hepatic function after hepatectomy and computed tomographic changes as indicators of mortality from hepatic failure. Surg Gynecol Obstet 1989; 169: 17-26
• 28 Farges O, Belghiti J, Kianmanesh R. et al. Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg 2003; 237: 208-217
• 29 Wakabayashi H, Ishimura K, Okano K. et al. Application of preoperative portal vein embolization before major hepatic resection in patients with normal or abnormal liver parenchyma. Surgery 2002; 131: 26-33
• 30 Uesaka K, Nimura Y, Nagino M. Changes in hepatic lobar function after right portal vein embolization: an appraisal by biliary indocyanine green excretion. Ann Surg 1996; 223: 77-83
• 31 Imamura H, Sano K, Sugawara Y. et al. Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepatobiliary Pancreat Surg 2005; 12: 16-22
• 32 Ohwada S, Kawate S, Hamada T. et al. Perioperative real-time monitoring of indocyanine green clearance by pulse spectrometry predicts remnant liver functional reserve in resection of hepatocellular carcinoma. Br J Surg 2006; 93: 339-346
• 33 Ducreux M, Ychou M, Laplanche A. et al. Hepatic arterial oxaliplatin infusion plus intravenous chemotherapy in colorectal cancer with inoperable hepatic metastases: a trial of the gastrointestinal group of the Fédération nationale des centres de lutte contre le cancer. J Clin Oncol 2005; 23: 4881-4887
• 34 Kaido T, Arii S, Shimada Y. et al. Portal embolization in various types of liver: novel variables to predict hypertrophy. Hepatogastroenterology 2003; 50: 140-145
• 35 Yamanaka N, Okamoto E, Oriyama T. et al. A prediction scoring system to select the surgical treatment of liver cancer: further refinement based on 10 years of use. Ann Surg 1994; 219: 342-346
• 36 Dinant S, Verwer BJ, Bennink RJ. et al. Predictive value of preoperative hepatobiliary scintigraphy on morbidity and mortality after partial liver resection. J Hepatobiliary Pancreat Surg 2005; 7(suppl 1): 29 (Abstract 47)
• 37 Panis Y, Ribeiro J, Chretien F. et al. Dormant liver metastases: an experimental study. Br J Surg 1992; 79: 221-223
• 38 Lee GH, Merlino G, Fausto N. Development of liver tumors in transforming growth factor alpha transgenic mice. Cancer Res 1992; 52: 5162-5170
• 39 Elias D, De Baere T, Roche A. et al. During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma. Br J Surg 1999; 86: 784-788
• 40 Kokudo N, Tada K, Seki M. et al. Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology 2001; 34: 267-272
• 41 Jaeck D, Bachellier P, Nakano H. et al. One or two-stage hepatectomy combined with portal vein embolization for initially nonresectable colorectal liver metastases. Am J Surg 2003; 185: 221-229
• 42 Elias D, Santoro R, Ouellet JF. et al. Simultaneous percutaneous right portal vein embolization and left liver radiofrequency ablation prior to a major right hepatic resection for bilateral colorectal metastases. Hepatogastroenterology 2004; 51: 1788-1791
• 43 Goere D, Farges O, Leporrier J. et al. Chemotherapy does not impair hypertrophy of the left liver after right portal vein obstruction. J Gastrointest Surg 2006; 10: 365-370
• 44 Selzner N, Pestalozzi C, Kadry Z. et al. Downstaging colorectal liver metastases by concomitant unilateral portal vein ligation and selective intra-arterial chemotherapy. Br J Surg 2006; 93: 587-592
• 45 Elias D, Youssef O, Sideris L. et al. Evolution of missing colorectal liver metastases following inductive chemotherapy and hepatectomy. J Surg Oncol 2004; 86: 4-9