Factors influencing failure of progression to completion hepatectomy following liver venous deprivation procedures (PVE or DVE): a longitudinal observational study

Swizel A Cardoso; George Clarke; Ananya Nayak; Kunal Joshi; Ramanivas Sudereyan; Salil Karkhanis; Nikolaos Chatzizacharias; Keith J Roberts; Naveen Condati; Michail Papamichail; Ravi Marudanayagam; David Bartlett; Syed S Raza; Robert P Sutcliffe; Homoyoon Mehrzad; Bobby V M Dasari

doi:10.1016/j.hpb.2024.11.011

Factors influencing failure of progression to completion hepatectomy following liver venous deprivation procedures (PVE or DVE): a longitudinal observational study

HPB (Oxford). 2024 Dec 5:S1365-182X(24)02426-2. doi: 10.1016/j.hpb.2024.11.011. Online ahead of print.

Authors

Swizel A Cardoso¹, George Clarke¹, Ananya Nayak¹, Kunal Joshi¹, Ramanivas Sudereyan², Salil Karkhanis², Nikolaos Chatzizacharias¹, Keith J Roberts¹, Naveen Condati², Michail Papamichail¹, Ravi Marudanayagam¹, David Bartlett¹, Syed S Raza¹, Robert P Sutcliffe¹, Homoyoon Mehrzad², Bobby V M Dasari³

Affiliations

¹ Department of HPB Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK.
² Department of Interventional Radiology, Queen Elizabeth Hospital, Birmingham, UK.
³ Department of HPB Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK. Electronic address: Bobby.dasari@uhb.nhs.uk.

PMID: 39690102
DOI: 10.1016/j.hpb.2024.11.011

Abstract

Background: Two-staged hepatectomy (TSH) with portal (PVE) or dual vein embolization (DVE) gained acceptance in liver surgery. The current study assesses the incidence and causes of failure to progress to completion hepatectomy following PVE/DVE and its influence on overall survival (OS).

Methods: This is a longitudinal observational study of patients who underwent PVE or DVE between April 2010-December 2023. Future liver remnant (FLR) volume was measured at least four weeks later. Restaging and resectability was assessed on imaging performed within 6-8 weeks of planned completion surgery.

Results: 130 patients underwent PVE (90) or DVE (40) during the study period. Of these, 73 (56 %) patients proceeded to definitive resection. Reasons for failure to progress to completion surgery were: disease progression (79 %), declined fitness for surgery (3.5 %) and inadequate FLR volume (14 %). Synchronous disease is a poor prognostic factor for achieving completion hepatectomy CRLM patients (p = 0.009). The median OS with and without completion hepatectomy was 38 months vs. 13 months in CRLM patients (p=<.001) and 31 months vs. 26 months in pCCA groups respectively (p = 0.471).

Conclusion: A significant percentage of patients did not progress to completion hepatectomy due to disease progression. Patient selection and efficient pathways are essential to improve resection rates following these resource-intensive procedures.