Portal vein embolization and subsequent major hepatectomy for hepatocellular carcinoma with insufficient residual liver volume: experience of a tertiary center.
| Title: | Portal vein embolization and subsequent major hepatectomy for hepatocellular carcinoma with insufficient residual liver volume: experience of a tertiary center. |
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| Authors: | Tran LCD; Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Nguyen TQ; Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Dadam MN; Online Research Club, Nagasaki, Japan.; Department of Orthopedics and Trauma Surgery, Helios Klinikum Schwelm, Schwelm, Germany.; Nguyen TD; Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Le DT; Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Dang VQ; Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Pham PH; Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Phan NP; Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Vo TQ; Department of Hepatobiliary and Pancreatic Surgery, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.; Cucè F; General and Upper G.I. Surgery Division, Surgery, Dentistry, Maternity and Infant Department, University of Verona, Verona, Italy.; Abdallfatah A; Faculty of Medicine, October 6 University, Giza, Egypt.; Huy NT; Institute of Research and Development, Duy Tan University, Da Nang, Vietnam. nguyentienhuy4@duytan.edu.vn.; School of Medicine and Pharmacy, Duy Tan University, Da Nang, Vietnam. nguyentienhuy4@duytan.edu.vn.; Graduate School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, 852-8523, Japan. nguyentienhuy4@duytan.edu.vn. |
| Source: | Updates in surgery [Updates Surg] 2025 Sep; Vol. 77 (5), pp. 1481-1490. Date of Electronic Publication: 2025 Apr 22. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Springer-Verlag Italia Country of Publication: Italy NLM ID: 101539818 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2038-3312 (Electronic) Linking ISSN: 2038131X NLM ISO Abbreviation: Updates Surg Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Milano : Springer-Verlag Italia |
| MeSH Terms: | Hepatectomy*/methods ; Carcinoma, Hepatocellular*/surgery ; Carcinoma, Hepatocellular*/therapy ; Carcinoma, Hepatocellular*/pathology ; Carcinoma, Hepatocellular*/mortality ; Liver Neoplasms*/surgery ; Liver Neoplasms*/therapy ; Liver Neoplasms*/pathology ; Liver Neoplasms*/mortality ; Embolization, Therapeutic*/methods ; Portal Vein*; Postoperative Complications/epidemiology ; Liver/pathology ; Liver Failure/epidemiology ; Liver Failure/etiology ; Humans ; Male ; Female ; Middle Aged ; Retrospective Studies ; Aged ; Tertiary Care Centers ; Organ Size ; Adult ; Treatment Outcome ; Liver Regeneration |
| Abstract: | Portal vein embolization (PVE) allows for liver regeneration to enhance reduced residual liver volume before resection in hepatocellular carcinoma (HCC) patients with systemic liver disease. A retrospective review of medical records was conducted, including patients who underwent PVE and subsequent major hepatectomy to treat resectable non-metastatic HCC at the University Medical Center in Ho Chi Minh City between 01/2016 and 6/2023. Patient demographics, timing of procedures, surgical interventions, intra- and postoperative complications, pattern of recurrence, and survival were analyzed. A total of 58 patients with HCC were included, and the median length of stay after surgery was 8 days (range 5-24). Post-hepatectomy liver failure (PHLF) occurred with an overall incidence of 31% (18/58 cases). Severe PHLF occurred in 6 cases: grade B in 5 cases (8.6%) and grade C in 1 case (1.7%), resulting in patient death. Postoperative bleeding and bile leak each occurred in 1 case (1.7%). Univariable and multivariable analyses identified portal vein pressure (PVP) after PVE as the only significant preoperative parameter associated with outcomes, correlating with PHLF occurrence (OR 1.27, p = 0.009) at a cut-off of 15 mmHg (p = 0.018). The overall survival at 3, 6, and 12 months was 96%, 94%, and 94%, respectively, with disease-free survival rates of 94%, 90%, and 87%, respectively. Major hepatectomy can be performed safely and effectively in HCC patients who have PVE-induced liver hypertrophy (sFLR ≥ 40%) and preserved liver function (Child-Pugh A) maintaining low morbidity. Multivariate analysis revealed that a post-PVE PVP cutoff of 15 mmHg significantly correlated with perioperative parameters, including operating time, blood loss, and PHLF occurrence.; (© 2025. Italian Society of Surgery (SIC).) |
| Competing Interests: | Declarations. Conflict of interest: The authors declare that there is no conflict of interest. Ethical approval: This study was conducted in accordance with the ethical standards of the Ethical Board of Biomedical Research of University of Medicine and Pharmacy at Ho Chi Mihn city and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Research involving human participants: All procedures involving human participants were approved by the Ethical Board of Biomedical Research of University of Medicine and Pharmacy at Ho Chi Mihn city (Approval Number: 24260-ĐHYD.s). Informed consent: For this type of retrospective study, formal consent is not required. Research involving animals: This article does not contain any studies with animals performed by any of the authors. |
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| Contributed Indexing: | Keywords: Hepatectomy; Hepatocellular carcinoma (HCC); Portal vein embolization (PVE); Post-hepatectomy liver failure (PHLF) |
| Entry Date(s): | Date Created: 20250422 Date Completed: 20250909 Latest Revision: 20250909 |
| Update Code: | 20260130 |
| DOI: | 10.1007/s13304-025-02190-5 |
| PMID: | 40261573 |
| Database: | MEDLINE |
Journal Article