Ann Surg Treat Res.  2017 May;92(5):348-354. 10.4174/astr.2017.92.5.348.

Streamline flow of the portal vein affects the lobar distribution of colorectal liver metastases and has a clinical impact on survival

• Rhu J
• Heo JS
• Choi SH
• Choi DW
• Kim JM
• Joh JW
• Kwon CH

• KMID: 2377705
• DOI: http://doi.org/10.4174/astr.2017.92.5.348

Abstract

PURPOSE
It is believed that blood from the superior mesenteric vein and splenic vein mixes incompletely in the portal vein and maintains a streamline flow influencing its anatomic distribution. Although several experimental studies have demonstrated the existence of streamlining, clinical studies have shown conflicting results. We investigated whether streamlining of portal vein affects the lobar distribution of colorectal liver metastases and estimated its impact on survival.
METHODS
Data of patients who underwent hepatectomy for colorectal liver metastases were retrospectively collected. The chi-square test was used for analyzing the distribution of metastasis. Cox analysis was used to identify risk factors of survival. Fisher exact test was used for subgroup analysis comparing hepatic recurrence.
RESULTS
A total of 410 patients were included. The right-to-left ratio of liver metastases were 2.20:1 in right-sided colon cancer and 1.39:1 in left-sided cancer (P = 0.017). Cox analyses showed that margin < 5 mm (P < 0.001; 95% confidence interval [CI], 1.648-4.884; hazard ratio [HR], 2.837), age ≥ 60 years (P = 0.004; 95% CI, 1.269-3.641; HR, 2.149), N2 status (P < 0.001, 95% CI, 1.598-4.215; HR, 2.595), tumor size ≥ 45 mm (P = 0.014; 95% CI, 1.159-3.758; HR, 2.087) and other metastasis (P = 0.012; 95% CI, 1.250-5.927; HR, 2.722) were risk factors of survival. However, in 70 patients who underwent right hemihepatectomy for solitary metastasis, left-sided colorectal cancer was a risk factor (P = 0.019; 95% CI, 1.293-17.956; HR, 4.818), and was associated with higher recurrence than right-sided cancer (43.1% and 15.8%, respectively, P = 0.049).
CONCLUSION
This study showed significant difference in lobar distribution of liver metastases between right colon cancer and left colorecral cancer. Furthermore, survival of left-sided colorectal cancer was poorer than that of right-sided cancer in patients who underwent right hemihepatectomy for solitary metastasis. These findings can be helpful for clinicians planning treatment strategy.

Keyword

Colorectal liver metastasis; Streamline flow; Portal vein; Colon cancer; Liver metastasis

MeSH Terms

Colonic Neoplasms
Colorectal Neoplasms
Hepatectomy
Humans
Liver*
Mesenteric Veins
Neoplasm Metastasis*
Portal Vein*
Recurrence
Retrospective Studies
Risk Factors
Splenic Vein

Figure

• 

  Fig. 1 “Streamline flow of the PV” is a theory stating that blood from the superior mesenteric vein (SMV) and inferior mesenteric vein (IMV) mix incompletely in the PV, resulting in disproportionate lobar distribution within the liver. The SMV distributes mainly to the right lobe compared to the IMV, which supplies both hemilivers similarly. PV, portal vein; SV, splenic vein; SMV, superior mesenteric vein; IMV, inferior mesenteric vein; RPV, right PV; LPV, left PV.

• 

  Fig. 2 In 70 patients who underwent right hemihepatectomy for solitary liver metastasis of colorectal cancer, left-sided colorectal cancer was a significant risk factor of survival, while right-sided colon cancer was not (P = 0.019; hazard ratio, 4.818).

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