Introduction PVE facilitates hepatectomy in patients with a small anticipated future liver remnant, but stimulates tumour growth. Hypoxia may mediate this increased tumour growth as Hypoxia-Inducible-Factor-1α (HIF-1α) increases angiogenesis and invasion. A tendency to reduced survival following liver resection after PVE was noted in a previous study when compared with a case matched non PVE-group. We have performed a longer term follow up of patients who had a PVE prior to resection of CRLM and compared the outcome with a matched controlled group with measurement of tumour hypoxia.
Methods Twenty-six patients who had PVE were compared with 25 case matched controls. Immunostaining was performed on serial formalin-fixed-paraffin-embedded CRLM sections for hypoxia regulated factors, HIF-1α and CA-9, vascular endothelial growth factor (VEGF) and a blood vessel marker, CD31. Disease progression, liver specific recurrence and actuarial survival were recorded.
Results The clinicopathological characteristics of the cancers were comparable between the groups. The median follow-up was 115 months (range 106–124). Overall, 5 year, local hepatic recurrence-free survival and progression-free periods were reduced in those patients undergoing PVE (p = 0.026, p = 0.060, p = 0.001 and p = 0.008 respectively). The expression of hypoxia markers between the groups was similar.
Conclusion This is the first long-term (>5 year) case matched series on outcome of patients with CRLM resected following PVE. Whilst, PVE facilitates potentially curative resection of CRLM, prognosis is less than those patients not requiring PVE. The mechanism behind this survival difference has not been established.
Disclosure of Interest None Declared
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