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Safety and feasibility of preoperative simultaneous portal vein embolization and biliary drainage in hilar cholangiocarcinoma prior to hepatectomy

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Submitted   Nov 13, 2023
Published   Jan 22, 2024
Issue    Vol 5 (2023)
DOI   10.25082/CCR.2023.01.003

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Mohamed M. Soliman
Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Olivier Chevallier
[1] Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; [2] Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France
Sara Velayati
Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Ken Zhao
Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Brett Marinelli
Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Fourat Ridouani
Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Anita Karimi
Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Anne Covey
Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Joseph P. Erinjeri
Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Mark Schattner
Department of Gastroenterology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
James J. Harding
Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Ghassan K. Abou-Alfa
Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Alice C. Wei
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Kevin C. Soares
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
William Jarnagin
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Hooman Yarmohammadi corresponding author
Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Abstract

Purpose: Evaluate safety and feasibility of simultaneous biliary drainage (BD) and portal vein embolization (PVE) prior to hepatectomy in hilar cholangiocarcinoma (HCCA) patients.
Methods: From January 2010 to June 2022, patients with potentially surgically resectable HCCA who underwent preoperative PVE and BD were analyzed. Type of initial BD, time interval between BD and PVE, changes in future liver remnant (FLR), time interval between BD, PVE and resection, and complications were recorded. Patients were divided into 3 groups based on the BD-PVE interval: Group A: simultaneous BD and PVE or within 7 days (d), n = 6; Group B: d ≥ 7 to ≤ 30, n = 7; Group C: d > 30, n = 14). Primary endpoints were post-PVE complications, FLR change, and resection rate. Secondary endpoints were Clavien-Dindo ≥ 3, Grade B/C Post Hepatectomy Liver Failure (PHLF) and 90 days mortality rate.
Results: A total of 27 patients (mean age = 64.4 +/- 11.2 years) underwent both BD and PVE prior to hepatectomy. Mean degree of hypertrophy at 4-6 weeks post-PVE was 10.4 +/- 3.7% with no significant difference between the 3 groups (p > 0.05). Resection was 67% in Group A, and 57% and 36% in groups B and C respectively (p < 0.05). Time to surgery was 38.5 +/- 12 days in Group A, and 60 and 147 days in groups B and C respectively (p = 0.002). No major post PVE SIR complication was reported in group A. Overall rate of Grade III/IV Clavien-Dindo complication was 61.5% with no difference among the three groups (50%, 75%, and 60%; groups A, B and C, respectively). Overall PHLF Grade B/C was reported in 46.2% of patients. No patients in Group A demonstrated Grade B/C PHLF.
Conclusion: Simultaneous BD and PVE is safe and reduces the time to surgery, which may help contribute to a higher rate of surgical resection.

Keywords
cholangiocarinoma, portal vein embolization, biliary drainage, hepatic resection, optimal timing

Article Details

How to Cite
Soliman, M. M., Chevallier, O., Velayati, S., Zhao, K., Marinelli, B., Ridouani, F., Karimi, A., Covey, A., Erinjeri, J. P., Schattner, M., Harding, J. J., Abou-Alfa, G. K., Wei, A. C., Soares, K. C., Jarnagin, W., & Yarmohammadi, H. (2024). Safety and feasibility of preoperative simultaneous portal vein embolization and biliary drainage in hilar cholangiocarcinoma prior to hepatectomy. Current Cancer Reports, 5(1), 160-167. https://doi.org/10.25082/CCR.2023.01.003
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