Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma

Jens Smits; Steven Chau; Sinéad James; Remon Korenblik; Madita Tschögl; Pieter Arntz; Jan Bednarsch; Luis Abreu de Carvalho; Olivier Detry; Joris Erdmann; Thomas Gruenberger; Laurens Hermie; Ulf Neumann; Per Sandström; Robert Sutcliffe; Alban Denys; Emmanuel Melloul; Maxime Dewulf; Christiaan van der Leij; Ronald M. van Dam; Patrick Chevallier; Stephen Wigmore; Timothy Newhook; Jean Nicolas Vauthey; Riccardo Memeo; Bobby VM Dasari; Eva Braunwarth; Luca Aldrighetti; Laurens van Baardewijk; Louise Barbier; Christoph Binkert; Bergthor Björnsson; Esteban Cugat Andorrà; Bulent Arslan; Ivan Baclija; Marc Bemelmans; Clare Bent; Marieke T. de Boer; Reinoud P.H. Bokkers; Diederick de Boo; David Breen; Stefan Breitenstein; Philipp Bruners; Alberta Cappelli; Ulrik Carling; Margarida Casellas i Robert; Benjamin Chan; Steven Olde Damink; EuroLVD and DRAGON Trials Collaborative

doi:10.1016/j.hpb.2024.07.407

Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma

Jens Smits
, Steven Chau
, Sinéad James
, Remon Korenblik
, Madita Tschögl
, Pieter Arntz
, Jan Bednarsch
, Luis Abreu de Carvalho
, Olivier Detry
, Joris Erdmann
, Thomas Gruenberger
, Laurens Hermie
, Ulf Neumann
, Per Sandström
, Robert Sutcliffe
, Alban Denys
, Emmanuel Melloul
, Maxime Dewulf^*
, Christiaan van der Leij
, Ronald M. van Dam^*

Patrick Chevallier, Stephen Wigmore, Timothy Newhook, Jean Nicolas Vauthey, Riccardo Memeo, Bobby VM Dasari, Eva Braunwarth, Luca Aldrighetti, Laurens van Baardewijk, Louise Barbier, Christoph Binkert, Bergthor Björnsson, Esteban Cugat Andorrà, Bulent Arslan, Ivan Baclija, Marc Bemelmans, Clare Bent, Marieke T. de Boer, Reinoud P.H. Bokkers, Diederick de Boo, David Breen, Stefan Breitenstein, Philipp Bruners, Alberta Cappelli, Ulrik Carling, Margarida Casellas i Robert, Benjamin Chan, Steven Olde Damink, EuroLVD and DRAGON Trials Collaborative

^*Corresponding author for this work

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

Abstract

Background: Major hepatectomy in perihilar cholangiocarcinoma (pCCA) patients with a small future liver remnant (FLR) risks posthepatectomy liver failure (PHLF). This study examines combined portal and hepatic vein embolisation (PVE/HVE) to increase preoperative FLR volume and potentially decrease PHLF rates. Methods: In this retrospective, multicentre, observational study, data was collected from centres affiliated with the DRAGON Trials Collaborative and the EuroLVD registry. The study included pCCA patients who underwent PVE/HVE between July 2016 and January 2023. Results: Following PVE/HVE, 28% of patients (9/32) experienced complications, with 22% (7/32) necessitating biliary interventions for cholangitis. The median degree of hypertrophy after a median of 16 days was 16% with a kinetic growth rate of 6.8% per week. 69% of patients (22/32) ultimately underwent surgical resection. Cholangitis after PVE/HVE was associated with unresectability. After resection, 55% of patients (12/22) experienced complications, of which 23% (5/22) were Clavien-Dindo grade III or higher. The 90-day mortality after resection was 0%. Conclusion: PVE/HVE quickly enhances the kinetic growth rate in pCCA patients. Cholangitis impairs chances on resection significantly. Resection after PVE/HVE is associated with low levels of 90-day mortality. The study highlights the potential of PVE/HVE in improving safety and outcomes in pCCA undergoing resection.

Original language	English
Pages (from-to)	1458-1466
Number of pages	9
Journal	HPB
Volume	26
Issue number	12
Early online date	1 Jan 2024
DOIs	https://doi.org/10.1016/j.hpb.2024.07.407
Publication status	Published - Dec 2024

Keywords

Humans
Male
Retrospective Studies
Bile Duct Neoplasms/surgery
Female
Klatskin Tumor/surgery
Embolization, Therapeutic/adverse effects
Hepatectomy
Aged
Middle Aged
Portal Vein/surgery
Hepatic Veins
Treatment Outcome
Postoperative Complications/etiology
Time Factors
Liver Failure/etiology

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10.1016/j.hpb.2024.07.407Licence: CC BY

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Smits, J., Chau, S., James, S., Korenblik, R., Tschögl, M., Arntz, P., Bednarsch, J., Abreu de Carvalho, L., Detry, O., Erdmann, J., Gruenberger, T., Hermie, L., Neumann, U., Sandström, P., Sutcliffe, R., Denys, A., Melloul, E., Dewulf, M., van der Leij, C., ... EuroLVD and DRAGON Trials Collaborative (2024). Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma. HPB, 26(12), 1458-1466. https://doi.org/10.1016/j.hpb.2024.07.407

@article{96a20b1f7ff74a38a4f22cbedd16df99,

title = "Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma",

abstract = "Background: Major hepatectomy in perihilar cholangiocarcinoma (pCCA) patients with a small future liver remnant (FLR) risks posthepatectomy liver failure (PHLF). This study examines combined portal and hepatic vein embolisation (PVE/HVE) to increase preoperative FLR volume and potentially decrease PHLF rates. Methods: In this retrospective, multicentre, observational study, data was collected from centres affiliated with the DRAGON Trials Collaborative and the EuroLVD registry. The study included pCCA patients who underwent PVE/HVE between July 2016 and January 2023. Results: Following PVE/HVE, 28\% of patients (9/32) experienced complications, with 22\% (7/32) necessitating biliary interventions for cholangitis. The median degree of hypertrophy after a median of 16 days was 16\% with a kinetic growth rate of 6.8\% per week. 69\% of patients (22/32) ultimately underwent surgical resection. Cholangitis after PVE/HVE was associated with unresectability. After resection, 55\% of patients (12/22) experienced complications, of which 23\% (5/22) were Clavien-Dindo grade III or higher. The 90-day mortality after resection was 0\%. Conclusion: PVE/HVE quickly enhances the kinetic growth rate in pCCA patients. Cholangitis impairs chances on resection significantly. Resection after PVE/HVE is associated with low levels of 90-day mortality. The study highlights the potential of PVE/HVE in improving safety and outcomes in pCCA undergoing resection.",

keywords = "Humans, Male, Retrospective Studies, Bile Duct Neoplasms/surgery, Female, Klatskin Tumor/surgery, Embolization, Therapeutic/adverse effects, Hepatectomy, Aged, Middle Aged, Portal Vein/surgery, Hepatic Veins, Treatment Outcome, Postoperative Complications/etiology, Time Factors, Liver Failure/etiology",

author = "Jens Smits and Steven Chau and Sin{\'e}ad James and Remon Korenblik and Madita Tsch{\"o}gl and Pieter Arntz and Jan Bednarsch and \{Abreu de Carvalho\}, Luis and Olivier Detry and Joris Erdmann and Thomas Gruenberger and Laurens Hermie and Ulf Neumann and Per Sandstr{\"o}m and Robert Sutcliffe and Alban Denys and Emmanuel Melloul and Maxime Dewulf and \{van der Leij\}, Christiaan and \{van Dam\}, \{Ronald M.\} and Patrick Chevallier and Stephen Wigmore and Timothy Newhook and Vauthey, \{Jean Nicolas\} and Riccardo Memeo and Dasari, \{Bobby VM\} and Eva Braunwarth and Luca Aldrighetti and \{van Baardewijk\}, Laurens and Louise Barbier and Christoph Binkert and Bergthor Bj{\"o}rnsson and Andorr{\`a}, \{Esteban Cugat\} and Bulent Arslan and Ivan Baclija and Marc Bemelmans and Clare Bent and \{de Boer\}, \{Marieke T.\} and Bokkers, \{Reinoud P.H.\} and \{de Boo\}, Diederick and David Breen and Stefan Breitenstein and Philipp Bruners and Alberta Cappelli and Ulrik Carling and \{Casellas i Robert\}, Margarida and Benjamin Chan and \{Olde Damink\}, Steven and \{EuroLVD and DRAGON Trials Collaborative\}",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = dec,

doi = "10.1016/j.hpb.2024.07.407",

language = "English",

volume = "26",

pages = "1458--1466",

journal = "HPB",

issn = "1365-182X",

publisher = "Elsevier B.V.",

number = "12",

}

Smits, J, Chau, S , James, S , Korenblik, R, Tschögl, M, Arntz, P, Bednarsch, J, Abreu de Carvalho, L, Detry, O, Erdmann, J, Gruenberger, T, Hermie, L, Neumann, U, Sandström, P, Sutcliffe, R, Denys, A, Melloul, E, Dewulf, M , van der Leij, C , van Dam, RM, Chevallier, P, Wigmore, S, Newhook, T, Vauthey, JN, Memeo, R, Dasari, BVM, Braunwarth, E, Aldrighetti, L, van Baardewijk, L, Barbier, L, Binkert, C, Björnsson, B, Andorrà, EC, Arslan, B, Baclija, I, Bemelmans, M, Bent, C, de Boer, MT, Bokkers, RPH, de Boo, D, Breen, D, Breitenstein, S, Bruners, P, Cappelli, A, Carling, U, Casellas i Robert, M, Chan, B, Olde Damink, S & EuroLVD and DRAGON Trials Collaborative 2024, 'Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma', HPB, vol. 26, no. 12, pp. 1458-1466. https://doi.org/10.1016/j.hpb.2024.07.407

TY - JOUR

T1 - Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma

AU - Smits, Jens

AU - Chau, Steven

AU - James, Sinéad

AU - Korenblik, Remon

AU - Tschögl, Madita

AU - Arntz, Pieter

AU - Bednarsch, Jan

AU - Abreu de Carvalho, Luis

AU - Detry, Olivier

AU - Erdmann, Joris

AU - Gruenberger, Thomas

AU - Hermie, Laurens

AU - Neumann, Ulf

AU - Sandström, Per

AU - Sutcliffe, Robert

AU - Denys, Alban

AU - Melloul, Emmanuel

AU - Dewulf, Maxime

AU - van der Leij, Christiaan

AU - van Dam, Ronald M.

AU - Chevallier, Patrick

AU - Wigmore, Stephen

AU - Newhook, Timothy

AU - Vauthey, Jean Nicolas

AU - Memeo, Riccardo

AU - Dasari, Bobby VM

AU - Braunwarth, Eva

AU - Aldrighetti, Luca

AU - van Baardewijk, Laurens

AU - Barbier, Louise

AU - Binkert, Christoph

AU - Björnsson, Bergthor

AU - Andorrà, Esteban Cugat

AU - Arslan, Bulent

AU - Baclija, Ivan

AU - Bemelmans, Marc

AU - Bent, Clare

AU - de Boer, Marieke T.

AU - Bokkers, Reinoud P.H.

AU - de Boo, Diederick

AU - Breen, David

AU - Breitenstein, Stefan

AU - Bruners, Philipp

AU - Cappelli, Alberta

AU - Carling, Ulrik

AU - Casellas i Robert, Margarida

AU - Chan, Benjamin

AU - Olde Damink, Steven

AU - EuroLVD and DRAGON Trials Collaborative

PY - 2024/12

Y1 - 2024/12

N2 - Background: Major hepatectomy in perihilar cholangiocarcinoma (pCCA) patients with a small future liver remnant (FLR) risks posthepatectomy liver failure (PHLF). This study examines combined portal and hepatic vein embolisation (PVE/HVE) to increase preoperative FLR volume and potentially decrease PHLF rates. Methods: In this retrospective, multicentre, observational study, data was collected from centres affiliated with the DRAGON Trials Collaborative and the EuroLVD registry. The study included pCCA patients who underwent PVE/HVE between July 2016 and January 2023. Results: Following PVE/HVE, 28% of patients (9/32) experienced complications, with 22% (7/32) necessitating biliary interventions for cholangitis. The median degree of hypertrophy after a median of 16 days was 16% with a kinetic growth rate of 6.8% per week. 69% of patients (22/32) ultimately underwent surgical resection. Cholangitis after PVE/HVE was associated with unresectability. After resection, 55% of patients (12/22) experienced complications, of which 23% (5/22) were Clavien-Dindo grade III or higher. The 90-day mortality after resection was 0%. Conclusion: PVE/HVE quickly enhances the kinetic growth rate in pCCA patients. Cholangitis impairs chances on resection significantly. Resection after PVE/HVE is associated with low levels of 90-day mortality. The study highlights the potential of PVE/HVE in improving safety and outcomes in pCCA undergoing resection.

AB - Background: Major hepatectomy in perihilar cholangiocarcinoma (pCCA) patients with a small future liver remnant (FLR) risks posthepatectomy liver failure (PHLF). This study examines combined portal and hepatic vein embolisation (PVE/HVE) to increase preoperative FLR volume and potentially decrease PHLF rates. Methods: In this retrospective, multicentre, observational study, data was collected from centres affiliated with the DRAGON Trials Collaborative and the EuroLVD registry. The study included pCCA patients who underwent PVE/HVE between July 2016 and January 2023. Results: Following PVE/HVE, 28% of patients (9/32) experienced complications, with 22% (7/32) necessitating biliary interventions for cholangitis. The median degree of hypertrophy after a median of 16 days was 16% with a kinetic growth rate of 6.8% per week. 69% of patients (22/32) ultimately underwent surgical resection. Cholangitis after PVE/HVE was associated with unresectability. After resection, 55% of patients (12/22) experienced complications, of which 23% (5/22) were Clavien-Dindo grade III or higher. The 90-day mortality after resection was 0%. Conclusion: PVE/HVE quickly enhances the kinetic growth rate in pCCA patients. Cholangitis impairs chances on resection significantly. Resection after PVE/HVE is associated with low levels of 90-day mortality. The study highlights the potential of PVE/HVE in improving safety and outcomes in pCCA undergoing resection.

KW - Humans

KW - Male

KW - Retrospective Studies

KW - Bile Duct Neoplasms/surgery

KW - Female

KW - Klatskin Tumor/surgery

KW - Embolization, Therapeutic/adverse effects

KW - Hepatectomy

KW - Aged

KW - Middle Aged

KW - Portal Vein/surgery

KW - Hepatic Veins

KW - Treatment Outcome

KW - Postoperative Complications/etiology

KW - Time Factors

KW - Liver Failure/etiology

U2 - 10.1016/j.hpb.2024.07.407

DO - 10.1016/j.hpb.2024.07.407

M3 - Article

C2 - 39277435

SN - 1365-182X

VL - 26

SP - 1458

EP - 1466

JO - HPB

JF - HPB

IS - 12

ER -

Combined portal and hepatic vein embolisation in perihilar cholangiocarcinoma

Abstract

Keywords

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