Role of portal vein embolisation in hepatocellular carcinoma management and its effect on recurrence: an intention-to-treat analysis

Abstract

BACKGROUND: Portal vein embolisation (PVE) for hepatocellular carcinoma is complicated due to the presence of background liver disease, issue of progression of the primary tumor, and possible effect on micrometastasis on the contralateral side. Patients and methods: Fifty-four patients with inadequate functional residual liver volume (FRLV) were offered PVE during a seven-year period. Clinicopathological features were compared between 34 (63%) patients who had undergone curative resection and others. A control group was selected by matching each patient who underwent surgery after PVE (PVE group) with three controls having surgery without PVE. Cases were matched for vascular invasion, type of resection and year of surgery. Postoperative complication pattern of recurrence and survival were compared. RESULTS: PVE increased the FRLV in 66% of the cirrhotic patients. Combination of PVE and surgery was effective in 60% (n = 32) of patients. Minor (control, 29%; PVE, 24%; p = 0.12) and major (PVE, 18%; control, 15%; p = 0.78) complications were similar between PVE and control groups. After a follow-up of 35 months (standard deviation 25 months), extrahepatic recurrence was detected in 10 (31%) and 41 (40%) cases in the PVE group and the control group, respectively (p = 0.25) and intrahepatic recurrence in 10 (29%) and 47 (46%) cases, respectively (p = 0.09). In the PVE group, 41% (n = 14) of the recurrences were detected before one year, compared to 42% (n = 43) in the control group (p = 1). Disease-free survival at 1, 3 and 5 years was 57, 29 and 26%, respectively, in the control group and 60, 42 and 42%, respectively, in the PVE group (log-rank, p = 0.33). On multivariate analysis, PVE was not an individual factor affecting survival (p = 0.82). CONCLUSION: PVE increases resectability and gives patients with hepatocellular carcinoma comparable outcomes.