Prolonged chemotherapy impairs liver regeneration after portal vein occlusion – An audit of 26 patients

Abstract 

Aim

The aim of the present retrospective study was to investigate the influence of neoadjuvant chemotherapy on liver regeneration after portal vein occlusion before major hepatectomy.

Method

Between 2003 and 2007, 26 patients underwent portal vein occlusion, of whom 22 had portal vein embolisation and 4 portal vein ligation. 15 of 23 patients with colorectal liver metastases had neoadjuvant chemotherapy.

Results

After portal vein occlusion, the ratio of the future liver remnant volume to total parenchymal liver volume (FLR%) was reduced in patients receiving neoadjuvant chemotherapy (27 ± 1% vs 32 ± 1%, p = 0.03). A smaller future liver remnant before portal vein occlusion resulted in a greater degree of hypertrophy (r² = 0.18, p = 0.04). Patients with tumour size greater than 60 mm showed a decreased degree of hypertrophy (7 ± 1)% as compared to patients with smaller tumours (13 ± 1%, p = 0.01). There was one death shortly after portal vein embolisation. 19/26 patients were resected with zero operative mortality.

Conclusion

Prolonged neoadjuvant chemotherapy has a small negative effect on liver regeneration induced by portal vein occlusion. Liver regeneration induced by portal vein occlusion is relatively large when tumour burden is small.

Keywords: Portal vein embolisation, Liver, Chemotherapy, Regeneration