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HPB (Oxford). 2012 Aug;14(8):523-31. doi: 10.1111/j.1477-2574.2012.00492.x. Epub 2012 May 31.

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

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1
Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.

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.

PMID:
22762400
PMCID:
PMC3406349
DOI:
10.1111/j.1477-2574.2012.00492.x
[Indexed for MEDLINE]
Free PMC Article
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