Oncological safety of portal vein embolization without prior tumour clearance in the future liver remnant followed by one-stage hepatectomy for bilateral colorectal liver metastases - Scorecard - MDSpire
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Oncological safety of portal vein embolization without prior tumour clearance in the future liver remnant followed by one-stage hepatectomy for bilateral colorectal liver metastases
Clinical Scorecard: Oncological Implications of Portal Vein Embolization Without Tumor Clearance Prior to One-Stage Hepatectomy for Bilateral Colorectal Liver Metastases
At a Glance
Category
Detail
Condition
Bilateral colorectal liver metastases (CRLM) with tumor in the future liver remnant (FLR)
Key Mechanisms
Portal vein embolization (PVE) induces hypertrophy of the FLR to enable safe major hepatectomy; tumor growth may be influenced by hypertrophy and growth hormones
Target Population
Patients with bilateral CRLM and metastases in the FLR requiring liver resection
Care Setting
Multicenter liver surgery centers performing regenerative liver surgery
Key Highlights
PVE without prior tumor clearance in the FLR followed by one-stage hepatectomy (PVE-OSH) can reduce the surgical burden compared to two-stage procedures.
ALPPS induces the most rapid hypertrophy, followed by PVE-OSH, then two-stage hepatectomy with PVE (TSH-PVE).
Postoperative outcomes including liver failure, mortality, and overall survival are comparable among PVE-OSH, TSH-PVE, and ALPPS.
Guideline-Based Recommendations
Diagnosis
Assess bilateral CRLM with metastases in the FLR using imaging (CT or MRI) and volumetric analysis to determine FLR volume.
Management
Consider PVE-OSH for patients with limited tumor burden in the FLR to avoid two-stage procedures.
Use PVE as the gold standard hypertrophy-inducing procedure when FLR is insufficient.
Select surgical approach (PVE-OSH, TSH-PVE, or ALPPS) based on tumor burden, FLR volume, and institutional protocols.
Monitoring & Follow-up
Monitor FLR hypertrophy post-PVE or ALPPS using volumetric imaging.
Evaluate for tumor progression during hypertrophy, considering chemotherapy to reduce progression risk.
Risks
Risk of liver recurrence is associated with number of metastases and use of ALPPS.
11% of PVE-OSH patients, 21% of TSH-PVE patients, and 4% of ALPPS patients may not proceed to successful resection.
Potential tumor progression during hypertrophy phase.
Patient & Prescribing Data
Patients with bilateral CRLM and metastases in the FLR undergoing regenerative liver surgery.
PVE-OSH offers a safe alternative to two-stage procedures with comparable postoperative outcomes and shorter interval to major resection compared to TSH-PVE.
Clinical Best Practices
Perform thorough preoperative volumetric analysis to assess FLR adequacy.
Administer chemotherapy during hypertrophy phase to mitigate tumor progression risk.
Tailor surgical approach to individual patient tumor burden and institutional expertise.
Consider PVE-OSH in patients with limited tumor burden in FLR to reduce treatment duration and complexity.
Monitor closely for liver recurrence postoperatively, especially in patients undergoing ALPPS or with multiple metastases.
by Tim Reese, Dennis Björk, Anne M H Longva, Kristian S Kiim, Maximilian Evers, Peter N Larsen, Nicolai A Schultz, Bård I Røsok, Ulrik Carling, Fredrik Holmquist, Gert Lindell, Per Sandström, Jörg Böcker, Stefan Gilg, Jennie Engstrand, Christian Sturesson, Karl J Oldhafer, Bergthor Björnsson, Ernesto Sparrelid
