BACKGROUND/AIM: Portal vein embolization (PVE) with autologous stem cells application (aHSC) is a method for future liver remnant volume (FLRV) increase. The aim of the study was to evaluate the positivite and negativite aspects of the method in clinical practice. PATIENTS AND METHODS: PVE with aHSC application was used in 32 patients with colorectal liver metastases and insufficient FLRV. Preoperative number of colorectal liver metastases (CLMs) was 5.2±3.6, CLMs volume 70.1±102.3 mm3 Results: FLRV growth occurred after 2-3 weeks in 31 (96.9%) patients, with volume increase from 528.2±170.5 to 715.4±143.3 ml (p=0.0001). Postoperative thirty days mortality, morbidity was 0% and 3.1%, respectively. Insufficient FLRV growth occurred in one patient. R0 liver resection was performed in 27(87.1%) patients. CLMs volume progression was in 5 (15.6%) patients from 680.0±59.4 to 723.1±57.1 ml (p=0.01). One and two-year overall survival were 88% and 62.9% respectively. Six and twelve-month recurrence-free survival rates were 50.7% and 39.6% respectively. CONCLUSION: PVE with aHSC application is a safe and useful method for FLRV growth. It significantly increases secondary CLMs resectability. However, it can cause CLMs progression. Liver resection should, therefore, be performed as soon as possible after achieving optimal increase of FLRV.

Biomedical Centre School of Medicine Pilsen Czech Republic

Department of Surgery School of Medicine University Hospital in Pilsen Pilsen Czech Republic

See more in PubMed

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–386. doi: 10.1002/ijc.29210. PubMed DOI

Vaz da Silva DG, Ribeiro HSC, Arra DASM, Torres SM, Diniz AL, Godoy AL, Farias IC, Costa Jr WL, Coimbra FJ. Predictors of long-term survival in patients with hepatic resection of colorectal metastases: Analysis of a Brazilian Cancer Center Cohort. J Surg Oncol. 2020;121:893–900. doi: 10.1002/jso.25893. PubMed DOI

Fukami Y, Kaneoka Y, Maeda A, Takayama Y, Onoe S, Isogai M. Simultaneous resection for colorectal cancer and synchronous liver metastases. Surgery Today. 2016;46:176–182. doi: 10.1007/s00595-015-1188-1. PubMed DOI

Russolillo N, Ratti F, Vigano L, Langella S, Cipriani F, Aldrighetti L, Ferrero A. The influence of aging on hepatic regeneration and early outcome after portal vein occlusion: A case-control study. Ann Surg Oncol. 2015;22:4046–4051. doi: 10.1245/s10434-015-4478-3. PubMed DOI

Yamashita S, Hasegawa K, Takahashi M, Arita J, Sakamoto Y, Aoki T, Sugawara Y, Kokudo N. Hobson’s choice two-stage hepatectomy for multiple and bilobar colorectal liver metastases with portal vein embolization: report of two cases. Surgery Today. 2015;45:511–516. doi: 10.1007/s00595-014-0953-x. PubMed DOI

Treska V. Methods to increase future liver remnant volume in patients with primarily unresectable colorectal liver metastases: Current State and Future Perspectives. Anticancer Res. 2016;36:2065–2072. PubMed

Moris D, Pawlik TM. Personalized treatment in patients with colorectal liver metastases. J Surg Res. 2017;216:26–29. doi: 10.1016/j.jss.2017.04.013. PubMed DOI

Kow AWC. Hepatic metastasis from colorectal cancer. J Gastrointest Oncol. 2019;10:1274–1298. doi: 10.21037/jgo.2019.08.06. PubMed DOI PMC

Dörr NM, Bartels M, Morgul MH. Current treatment of colorectal liver metastasis as a chronic disease. Anticancer Res. 2020;40:1–7. doi: 10.21037/jgo.2019.08.06. PubMed DOI

Schlitt HJ, Hackl C, Lang SA. ‘In-situ split’ liver resection/ALPPS - Historical development and current practice. Visc Med. 2017;33:408–412. doi: 10.1159/000479850. PubMed DOI PMC

Luz JHM, Gomes FV, Coimbra E, Costa NV, Bilhim T. Preoperative portal vein embolization in hepatic surgery: A review about the embolic materials and their effects on liver regeneration and outcome. Radiol Res Pract. 2020;21:1–9. doi: 10.1155/2020/9295852. PubMed DOI PMC

Imai K, Adam R, Baba H. How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective. Ann Gastroenterol Surg. 2019;3:476–486. doi: 10.1002/ags3.12276. PubMed DOI PMC

Albati NA, Korairi AA, Hasan IA, Almodhaiberi HK, Algarni AA. Outcomes of staged hepatectomies for liver malignancy. World J Hepatol. 2019;11:513–521. doi: 10.4254/wjh.v11.i6.513. PubMed DOI PMC

Huang HC, Bian J, Bai Y, Lu X, Xu YY, Sang XT, Zhao HT. Complete or partial split in associating liver partition and portal vein ligation for staged hepatectomy: A systematic review and meta-analysis. World J Gastroenterol. 2019;25:6016–6024. doi: 10.3748/wjg.v25.i39.6016. PubMed DOI PMC

Raptis DA, Linecker M, Kambakamba P, Tschuor C, Müller PC, Hadjittofi C, Stavrou GA, Fard-Aghaie MH, Tun-Abraham M, Ardiles V, Malagó M, Campos RR, Oldhafer KJ, Hernandez-Alejandro R, de Santibañes E, Machado MA, Petrowsky H, Clavien PA. Defining Benchmark Outcomes for ALPPS. Ann Surg. 2019;270:835–841. doi: 10.1097/SLA.0000000000003539. PubMed DOI

Niekamp AS, Huang SY, Mahvash A, Odisio BC, Ahrar K, Tzeng ChD, Vauthey JN. Hepatic vein embolization after portal vein embolization to induce additional liver hypertrophy in patients with metastatic colorectal carcinoma. Eur Radiol. 2020 doi: 10.1007/s00330-020-06746-4. PubMed DOI

Kobayashi K, Yamaguchi T, Denys A, Perron L, Halkic N, Demartines N, Melloul E. Liver venous deprivation compared to portal vein embolization to induce hypertrophy of the future liver remnant before major hepatectomy: A single center experience. Surgery. 2020;167:917–923. doi: 10.1016/j.surg.2019.12.006. PubMed DOI

Guiu B, Quenet F, Escal L, Bibeau F, Piron L, Rouanet P, Fabre JM, Jacquet E, Denys A, Kotzki PO, Verzilli D, Deshayes E. Extended liver venous deprivationbefore major hepatectomy induces marked and very rapid increase in futureliverremnant function. Eur Radiol. 2017;27:3343–3352. doi: 10.1007/s00330-017-4744-9. PubMed DOI

Treska V, Fichtl J, Ludvik J, Bruha J, Liska V, Treskova I, Kucera R, Topolcan O, Lysak D, Skalicky T, Ferda J. Portal vein embolization (PVE) versus PVE with haematopoietic stem cell application in patients with primarily non-resectable colorectal liver metastases. Anticancer Res. 2018;38:5531–5537. doi: 10.21873/anticanres.12888. PubMed DOI

Bruha J, Treska V, Mirka H, Hosek P, Fichtl J, Skalicky T, Bajcurova K, Ludvik J, Duras P, Lysak D, Liska V. Growth of colorectal liver metastases is not accelerated by intraportal administration of stem cells after portal vein embolization. Rozhl Chir. 2019;98:159–166. PubMed

Ironside N, Bell R, Bartlett A, McCall J, Powell J, Pandanaboyana S. Systematic review of perioperative and survival outcomes of liver resections with and without preoperative portal vein embolization for colorectal metastases. HPB (Oxford) 2017;19:559–566. doi: 10.1016/j.hpb.2017.03.003. PubMed DOI

Loes IM, Immervoll H, Sorbye H, Angelsen JH, Horn A, Knappskog S, Loning PE. Impact of KRAS, BRAF, PIK3CA, TP53 status and intraindividual mutation heterogeneity on outcome after liver resection for colorectal cancer metastases. Int J Cancer. 2016;139:647–656. doi: 10.1002/ijc.30089. PubMed DOI PMC

Scherman P, Syk I, Holmberg E, Naredi P, Rizell M. Influence of primary tumour and patient factors on survival in patients undergoing curative resection and treatment for liver metastases from colorectal cancer. BJS Open. 2020;4:118–132. doi: 10.1002/bjs5.50237. PubMed DOI PMC