Safety and efficacy of portal vein embolization with or without chemotherapy

Portal vein embolization (PVE) is performed preoperatively to increase the size of the functional liver remnant (FLR) after lobectomy. Withholding chemotherapy during the time between PVE and surgery may lead to tumor progression, though continuing chemotherapy may decrease the rate of growth of the liver remnant. The purpose was to characterize the effect of PVE on tumor and liver volume in patients who were or were not treated with chemotherapy. A total of 76 patients (30F, 46M) with an average age of 61 years (range 37-83) who underwent right PVE for right liver malignancy were included. Etiologies included colorectal cancer (44), hepatocellular carcinoma (HCC; 17), cholangiocarcinoma (10), gastrointestinal stromal tumor (2), and other (3). The pre- and post-PVE MRI or CT were assessed with TeraRecon (Foster City, CA) to calculate liver volumes, on average, 33 days before and 33 days after PVE. Chart review revealed chemotherapy administration, genetic profiling, and comorbidities. Nine patients received chemotherapy and 67 did not. Patients who did not receive chemotherapy had increased tumor volume (28%) whereas patients who received chemotherapy had decreased tumor volume (−24%) (p=0.026). However, there was no significant difference in the increase in FLR (28% vs. 34%; p=0.645) between patients who did and did not receive chemotherapy, respectively. Among the 30 patients with genetic profiling, 15 were wildtype and 15 had mutations including KRAS, TP53, and P13K. Patients with mutations had greater increased tumor volume (77%) compared to those without (10%) though this difference was not significant (p>0.5). The presence of mutations did not impact FLR growth (32% vs. 28%; p>0.15). Neither the presence of cirrhosis, hepatic steatosis, nor diabetes impacted changes in tumor or FLR volume (p>0.20). Chemotherapy given after PVE before hepatic lobectomy had no effect on FLR growth, however was associated with decreasing tumor volumes. Therefore, chemotherapy should not be withheld and may result in better outcomes.