ABSTRACT
BACKGROUND: The purpose of this study was to compare 3-year overall survival after simultaneous portal (PVE) and hepatic vein (HVE) embolization versus PVE alone in patients undergoing liver resection for primary and secondary cancers of the liver. METHODS: In this multicentre retrospective study, all DRAGON 0 centres provided 3-year follow-up data for all patients who had PVE/HVE or PVE, and were included in DRAGON 0 between 2016 and 2019. Kaplan-Meier analysis was undertaken to assess 3-year overall and recurrence/progression-free survival. Factors affecting survival were evaluated using univariable and multivariable Cox regression analyses. RESULTS: In total, 199 patients were included from 7 centres, of whom 39 underwent PVE/HVE and 160 PVE alone. Groups differed in median age (P = 0.008). As reported previously, PVE/HVE resulted in a significantly higher resection rate than PVE alone (92 versus 68%; P = 0.007). Three-year overall survival was significantly higher in the PVE/HVE group (median survival not reached after 36 months versus 20 months after PVE; P = 0.004). Univariable and multivariable analyses identified PVE/HVE as an independent predictor of survival (univariable HR 0.46, 95% c.i. 0.27 to 0.76; P = 0.003). CONCLUSION: Overall survival after PVE/HVE is substantially longer than that after PVE alone in patients with primary and secondary liver tumours.
Subject(s)
Embolization, Therapeutic , Hepatectomy , Hepatic Veins , Liver Neoplasms , Liver Regeneration , Portal Vein , Humans , Male , Female , Liver Neoplasms/therapy , Liver Neoplasms/mortality , Liver Neoplasms/surgery , Retrospective Studies , Embolization, Therapeutic/methods , Middle Aged , Liver Regeneration/physiology , Aged , Hepatectomy/methods , Survival Rate , Survival Analysis , AdultSubject(s)
Carcinoma, Hepatocellular/blood supply , Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic/methods , Liver Neoplasms/blood supply , Liver Neoplasms/therapy , Liver Transplantation , Portal Vein , Waiting Lists , Carcinoma, Hepatocellular/diagnostic imaging , Carcinoma, Hepatocellular/pathology , Disease Progression , Humans , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/pathology , Male , Middle Aged , Neoplasm Recurrence, Local , Portal Vein/diagnostic imaging , Treatment OutcomeABSTRACT
The indication for treatment of inferior mesenteric artery (IMA) is generally not clear. The IMA is frequently ignored owing to its size and the presence of alternate pathways within the mesenteric vasculature. However, IMA treatment may be indicated in certain clinical scenarios. In this article, we focus on the indications for IMA treatment and technical considerations when treatment is indicated.
