Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis

J. Heil; R. Korenblik; F. Heid; W.O. Bechstein; M. Bemelmans; C. Binkert; B. Bjornsson; S. Breitenstein; O. Detry; A. Dili; R.F. Dondelinger; L. Gerard; T. Gimenez-Maurel; B. Guiu; D. Heise; M. Hertl; J.A. Kalil; J.J. Klein; A. Lakoma; U.P. Neumann; B. Olij; S.G. Pappas; P. Sandstrom; A. Schnitzbauer; A. Serrablo; J. Tasse; C. Van der Leij; P. Metrakos; R. Van Dam; E. Schadde

doi:10.1093/bjs/znaa149

Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis

J. Heil, R. Korenblik, F. Heid, W.O. Bechstein, M. Bemelmans, C. Binkert, B. Bjornsson, S. Breitenstein, O. Detry, A. Dili, R.F. Dondelinger, L. Gerard, T. Gimenez-Maurel, B. Guiu, D. Heise, M. Hertl, J.A. Kalil, J.J. Klein, A. Lakoma, U.P. NeumannB. Olij, S.G. Pappas, P. Sandstrom, A. Schnitzbauer, A. Serrablo, J. Tasse, C. Van der Leij, P. Metrakos, R. Van Dam, E. Schadde^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Y Background: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability.Methods: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis.Results: In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P=0.020) and resectability (90 versus 68 per cent; P=0.007). Major complications (26 versus 34 per cent; P=0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders.Conclusion: PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.

Original language	English
Pages (from-to)	834-842
Number of pages	9
Journal	British Journal of Surgery
Volume	108
Issue number	7
DOIs	https://doi.org/10.1093/bjs/znaa149
Publication status	Published - 1 Jul 2021

Keywords

LIVER VENOUS DEPRIVATION
MAJOR HEPATECTOMY
HEPATOBILIARY SCINTIGRAPHY
REMNANT LIVER
RESECTION
HYPERTROPHY
VOLUME
LIGATION
METASTASES
MORTALITY

Access to Document

10.1093/bjs/znaa149

Cite this

Heil, J., Korenblik, R., Heid, F., Bechstein, W. O., Bemelmans, M., Binkert, C., Bjornsson, B., Breitenstein, S., Detry, O., Dili, A., Dondelinger, R. F., Gerard, L., Gimenez-Maurel, T., Guiu, B., Heise, D., Hertl, M., Kalil, J. A., Klein, J. J., Lakoma, A., ... Schadde, E. (2021). Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis. British Journal of Surgery, 108(7), 834-842. https://doi.org/10.1093/bjs/znaa149

@article{416ca1bcdec249daa0844a98184e4b08,

title = "Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis",

abstract = "Y Background: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability.Methods: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis.Results: In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P=0.020) and resectability (90 versus 68 per cent; P=0.007). Major complications (26 versus 34 per cent; P=0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders.Conclusion: PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.",

keywords = "LIVER VENOUS DEPRIVATION, MAJOR HEPATECTOMY, HEPATOBILIARY SCINTIGRAPHY, REMNANT LIVER, RESECTION, HYPERTROPHY, VOLUME, LIGATION, METASTASES, MORTALITY",

author = "J. Heil and R. Korenblik and F. Heid and W.O. Bechstein and M. Bemelmans and C. Binkert and B. Bjornsson and S. Breitenstein and O. Detry and A. Dili and R.F. Dondelinger and L. Gerard and T. Gimenez-Maurel and B. Guiu and D. Heise and M. Hertl and J.A. Kalil and J.J. Klein and A. Lakoma and U.P. Neumann and B. Olij and S.G. Pappas and P. Sandstrom and A. Schnitzbauer and A. Serrablo and J. Tasse and {Van der Leij}, C. and P. Metrakos and {Van Dam}, R. and E. Schadde",

year = "2021",

month = jul,

day = "1",

doi = "10.1093/bjs/znaa149",

language = "English",

volume = "108",

pages = "834--842",

journal = "British Journal of Surgery",

issn = "0007-1323",

publisher = "Wiley",

number = "7",

}

Heil, J, Korenblik, R, Heid, F, Bechstein, WO, Bemelmans, M, Binkert, C, Bjornsson, B, Breitenstein, S, Detry, O, Dili, A, Dondelinger, RF, Gerard, L, Gimenez-Maurel, T, Guiu, B, Heise, D, Hertl, M, Kalil, JA, Klein, JJ, Lakoma, A, Neumann, UP, Olij, B, Pappas, SG, Sandstrom, P, Schnitzbauer, A, Serrablo, A, Tasse, J, Van der Leij, C, Metrakos, P, Van Dam, R & Schadde, E 2021, 'Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis', British Journal of Surgery, vol. 108, no. 7, pp. 834-842. https://doi.org/10.1093/bjs/znaa149

TY - JOUR

T1 - Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis

AU - Heil, J.

AU - Korenblik, R.

AU - Heid, F.

AU - Bechstein, W.O.

AU - Bemelmans, M.

AU - Binkert, C.

AU - Bjornsson, B.

AU - Breitenstein, S.

AU - Detry, O.

AU - Dili, A.

AU - Dondelinger, R.F.

AU - Gerard, L.

AU - Gimenez-Maurel, T.

AU - Guiu, B.

AU - Heise, D.

AU - Hertl, M.

AU - Kalil, J.A.

AU - Klein, J.J.

AU - Lakoma, A.

AU - Neumann, U.P.

AU - Olij, B.

AU - Pappas, S.G.

AU - Sandstrom, P.

AU - Schnitzbauer, A.

AU - Serrablo, A.

AU - Tasse, J.

AU - Van der Leij, C.

AU - Metrakos, P.

AU - Van Dam, R.

AU - Schadde, E.

PY - 2021/7/1

Y1 - 2021/7/1

N2 - Y Background: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability.Methods: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis.Results: In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P=0.020) and resectability (90 versus 68 per cent; P=0.007). Major complications (26 versus 34 per cent; P=0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders.Conclusion: PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.

AB - Y Background: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability.Methods: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis.Results: In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P=0.020) and resectability (90 versus 68 per cent; P=0.007). Major complications (26 versus 34 per cent; P=0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders.Conclusion: PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.

KW - LIVER VENOUS DEPRIVATION

KW - MAJOR HEPATECTOMY

KW - HEPATOBILIARY SCINTIGRAPHY

KW - REMNANT LIVER

KW - RESECTION

KW - HYPERTROPHY

KW - VOLUME

KW - LIGATION

KW - METASTASES

KW - MORTALITY

U2 - 10.1093/bjs/znaa149

DO - 10.1093/bjs/znaa149

M3 - Article

C2 - 33661306

SN - 0007-1323

VL - 108

SP - 834

EP - 842

JO - British Journal of Surgery

JF - British Journal of Surgery

IS - 7

ER -