1
|
Soykan EA, Aarts BM, Lopez-Yurda M, Kuhlmann KFD, Erdmann JI, Kok N, van Lienden KP, Wilthagen EA, Beets-Tan RGH, van Delden OM, Gomez FM, Klompenhouwer EG. Predictive Factors for Hypertrophy of the Future Liver Remnant After Portal Vein Embolization: A Systematic Review. Cardiovasc Intervent Radiol 2021; 44:1355-1366. [PMID: 34142192 PMCID: PMC8382618 DOI: 10.1007/s00270-021-02877-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/18/2021] [Indexed: 12/15/2022]
Abstract
This systematic review was conducted to determine factors that are associated with the degree of hypertrophy of the future liver remnant following portal vein embolization. An extensive search on September 15, 2020, and subsequent literature screening resulted in the inclusion of forty-eight articles with 3368 patients in qualitative analysis, of which 18 studies were included in quantitative synthesis. Meta-analyses based on a limited number of studies showed an increase in hypertrophy response when additional embolization of segment 4 was performed (pooled difference of medians = − 3.47, 95% CI − 5.51 to − 1.43) and the use of N-butyl cyanoacrylate for portal vein embolization induced more hypertrophy than polyvinyl alcohol (pooled standardized mean difference (SMD) = 0.60, 95% CI 0.30 to 0.91). There was no indication of a difference in degree of hypertrophy between patients who received neo-adjuvant chemotherapy and those who did not receive pre-procedural systemic therapy (pooled SMD = − 0.37, 95% CI − 1.35 to 0.61), or between male and female patients (pooled SMD = 0.19, 95% CI − 0.12 to 0.50). The study was registered in the International Prospective Register of Systematic Reviews on April 28, 2020 (CRD42020175708).
Collapse
Affiliation(s)
- E. A. Soykan
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - B. M. Aarts
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M. Lopez-Yurda
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K. F. D. Kuhlmann
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J. I. Erdmann
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N. Kok
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K. P. van Lienden
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E. A. Wilthagen
- Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R. G. H. Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - O. M. van Delden
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - F. M. Gomez
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Interventional Radiology, Hospital Clinic Universitari de Barcelona, Barcelona, Spain
| | - E. G. Klompenhouwer
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Talebreza A, Yahaghi E, Bolvardi E, Masoumi B, Bahramian M, Darian EK, Ahmadi K. Investigation of clinicopathological parameters in emergency colorectal cancer surgery: a study of 67 patients. Arch Med Sci 2017; 13:1394-1398. [PMID: 29181070 PMCID: PMC5701685 DOI: 10.5114/aoms.2016.61385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/26/2016] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The aim of the present study was to establish, having adjusted for case mix, the size of the differences in postoperative mortality and 5-year survival between patients presenting as an emergency with evidence of obstruction and perforation and the association of clinicopathological factors with mortality (bivariate analyses). MATERIAL AND METHODS The study included 67 patients who presented with colorectal cancer (CRC) between 2009 and 2013 in Iran. The mean age of the patients was 59.7 years. Of the 67 patients, 37 (55.22%) were male and 30 (44.77%) were female. Certain parameters that correlated with CRC and surgical treatment were investigated. RESULTS Our results showed that 46 (68.65%) patients had obstruction, while perforation was observed in 21 (31.34%) cases. Among the patients with obstruction, obstruction of the right colon was observed in 29 (43.28%) cases. There was no significant difference in mortality rate between right and left colonic obstruction. Based on the bivariate analyses, our findings showed that death of patients was significantly related to tumor grade (p = 0.02) and TNM staging (p = 0.026), but no association was found between other parameters and death, including age, sex, and tumor site. CONCLUSIONS Compared with patients who undergo elective surgery for colon cancer, those who present as an emergency with evidence of obstruction or perforation have higher postoperative mortality rates and poorer cancer-specific survival. Also, colorectal cancer patients with emergency surgery showed aggressive histopathology and an advanced stage.
Collapse
Affiliation(s)
- Amir Talebreza
- Department of Surgery, AJA University of Medical Sciences, Tehran, Iran
| | - Emad Yahaghi
- Department of Molecular Biology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ehsan Bolvardi
- Department of Emergency Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Babak Masoumi
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehran Bahramian
- Department of Emergency Medicine, Madani Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Koorosh Ahmadi
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| |
Collapse
|
3
|
Komorowski AL, Mituś JW, Wysocki WM, Bała MM. Laparoscopic and open liver resection - a literature review with meta-analysis. Arch Med Sci 2017; 13:525-532. [PMID: 28507565 PMCID: PMC5420617 DOI: 10.5114/aoms.2015.55545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 07/20/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In recent years laparoscopic approach to liver resections has gained important attention from surgeons worldwide. The aim of this review was to compare the results of laparoscopic and open liver resections. MATERIAL AND METHODS We have performed a search in Medline, Embase and the Cochrane Library databases. Studies comparing laparoscopic and open liver resections were included. RESULTS No randomized clinical trial were identified. In the 16 observational studies included in the analysis there were 927 laparoscopic and 1049 open liver resections. The laparoscopy group had lower blood loss (MD = 244.93 ml, p < 0.00001), lower odds of transfusion (OR = 0.35, p = 0.0002), lower odds of positive margins on pathology report (OR = 0.22, p < 0.00001), lower odds of readmission (OR = 0.36, p = 0.04), lower odds of pulmonary (OR = 0.38, p = 0.003) and cardiac complications (OR = 0.30, p = 0.02) and lower odds of postoperative liver failure (OR = 0.24, p = 0.001), but in many cases the results were based on a low number of events reported in included studies. CONCLUSIONS Laparoscopic resection of liver yields complications rates comparable to open resection, but the results are based on low quality evidence from nonrandomised studies.
Collapse
Affiliation(s)
- Andrzej L. Komorowski
- Department of Surgical Oncology, Maria Skłodowska-Curie Memorial Institute of Oncology, Cancer Centre, Krakow, Poland
| | - Jerzy W. Mituś
- Department of Surgical Oncology, Maria Skłodowska-Curie Memorial Institute of Oncology, Cancer Centre, Krakow, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech M. Wysocki
- Department of Surgical Oncology, Maria Skłodowska-Curie Memorial Institute of Oncology, Cancer Centre, Krakow, Poland
| | - Małgorzata M. Bała
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
4
|
Zacharias T, Ferreira N. Nutritional risk screening 2002 and ASA score predict mortality after elective liver resection for malignancy. Arch Med Sci 2017; 13:361-369. [PMID: 28261289 PMCID: PMC5332458 DOI: 10.5114/aoms.2017.65273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/10/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The aim of the study was to evaluate whether Nutritional risk screening 2002 (NRS 2002) at hospital admission may predict postoperative mortality and complications within 90 days after elective liver resection for malignancy. MATERIAL AND METHODS A retrospective cohort study of a prospective database was performed. Two-hundred and three patients with elective liver resection for malignancy between 9 November 2007 and 27 May 2014 were included. Clinical data, NRS 2002, surgical procedures and histology were recorded. The primary endpoint was 90-day mortality. Complications were registered within 90 days postoperatively according to the Clavien-Dindo classification. RESULTS The 90-day mortality was 5.9% and the overall complication rate was 59.1%. Multivariate analysis identified NRS 2002 score ≥ 4 (odds ratio (OR) = 9.24; p = 0.005) and American Society of Anesthesiologists (ASA) score ≥ 3 (OR = 6.20; p = 0.009) as predictors of 90-day mortality. The 90-day mortality was 27.6% (8/29) for patients with both risk factors (NRS 2002 score ≥ 4 and ASA score ≥ 3) vs. 2.3% (4/174) for patients without or with only one risk factor (p < 0.001). CONCLUSIONS In the present study NRS 2002 score ≥ 4 and ASA score ≥ 3 were predictors of 90-day mortality after elective liver resection for malignancy.
Collapse
Affiliation(s)
- Thomas Zacharias
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Emile Muller, Mulhouse, France
| | - Nelio Ferreira
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Hôpital Emile Muller, Mulhouse, France
| |
Collapse
|
5
|
Eshmuminov D, Raptis DA, Linecker M, Wirsching A, Lesurtel M, Clavien PA. Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy. Br J Surg 2016; 103:1768-1782. [PMID: 27633328 DOI: 10.1002/bjs.10290] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Discussion is ongoing regarding whether associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) or portal vein occlusion is better in staged hepatectomy. The aim of this study was to compare available strategies using a two-stage approach in extended hepatectomy. METHODS A literature search was performed in MEDLINE, Scopus, the Cochrane Library and Embase, and additional articles were identified by hand searching. Data from the international ALPPS registry were extracted. Clinical studies reporting volumetric changes, mortality, morbidity, feasibility of the second stage and tumour-free resection margins (R0) in two-stage hepatectomy were included. RESULTS Ninety studies involving 4352 patients, including 320 from the ALPPS registry, met the inclusion criteria. Among these, nine studies (357 patients) reported on comparisons with other strategies. In the comparison of ALPPS versus portal vein embolization (PVE), ALPPS was associated with a greater increase in the future liver remnant (76 versus 37 per cent; P < 0·001) and more frequent completion of stage 2 (100 versus 77 per cent; P < 0·001). Compared with PVE, ALPPS had a trend towards higher morbidity (73 versus 59 per cent; P = 0·16) and mortality (14 versus 7 per cent; P = 0·19) after stage 2. In the non-comparative studies, complication rates were 39 per cent in the PVE group, 47 per cent in the portal vein ligation (PVL) group and 70 per cent in the ALPPS group. After stage 2, mortality rates were 5, 7 and 12 per cent respectively. CONCLUSION ALPPS is associated with greater future liver remnant hypertrophy and a higher rate of completion of stage 2, but this may be at the price of greater morbidity and mortality.
Collapse
Affiliation(s)
- D Eshmuminov
- Department of Surgery, Swiss HPB and Transplantation Centre, University Hospital Zurich, Zurich, Switzerland
| | - D A Raptis
- Department of Surgery, Swiss HPB and Transplantation Centre, University Hospital Zurich, Zurich, Switzerland
| | - M Linecker
- Department of Surgery, Swiss HPB and Transplantation Centre, University Hospital Zurich, Zurich, Switzerland
| | - A Wirsching
- Department of Surgery, Swiss HPB and Transplantation Centre, University Hospital Zurich, Zurich, Switzerland
| | - M Lesurtel
- Department of Surgery, Swiss HPB and Transplantation Centre, University Hospital Zurich, Zurich, Switzerland.,Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - P-A Clavien
- Department of Surgery, Swiss HPB and Transplantation Centre, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
6
|
Al-Sharif E, Simoneau E, Hassanain M. Portal vein embolization effect on colorectal cancer liver metastasis progression: Lessons learned. World J Clin Oncol 2015; 6:142-146. [PMID: 26468450 PMCID: PMC4600188 DOI: 10.5306/wjco.v6.i5.142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/07/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023] Open
Abstract
Colorectal liver metastasis (CRLM) is the major cause of death in patients diagnosed with colorectal cancer. The gold standard treatment of CRLM is surgical resection. Yet, in the past, more than half of these patients were deemed unresectable due to the inadequate future liver remnant (FLR). The introduction of efficient portal vein embolization (PVE) preoperatively allowed more resections of metastasis in CRLM patients by stimulating adequate liver hypertrophy. However, several experimental and clinical studies reported tumor progression after PVE which critically influences the subsequent management of these patients. The underlying pathophysiological mechanism of tumor progression post-PVE is still not fully understood. In spite of the adverse effects of PVE, it remains a potentially curative procedure in patients who would remain otherwise unresectable because of the insufficient FLR. Currently, the challenge is to halt tumor proliferation following PVE in patients who require this technique. This could potentially be achieved by either attempting to suppress the underlying oncologic stimulus or by inhibiting tumor growth once observed after PVE, without jeopardizing liver regeneration. More research is still required to better identify patients at risk of experiencing tumor growth post-PVE.
Collapse
|