Evidence map›Paper›PMID 40255933›Full record

ArticleThe Lancet regional health. Europe2025

Safety and efficacy of combined portal and hepatic vein embolisation in patients with colorectal liver metastases (DRAGON1): a multicentre, single-arm clinical trial.

Remon Korenblik, Sinéad James, Jens Smits, Rafael Díaz-Nieto, Rob Davis, Benjamin K Y Chan, Joris I Erdmann, IJsbrand A J Zijlstra, Pieter J W Arntz, Otto Kollmar and 76 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet regional health. Europe, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04272931 (DRAGON 1- Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization to Accelerate Future Liver Remnant), which is not on this map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04272931 naunknown statusnot on this map

DRAGON 1- Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization to Accelerate Future Liver Remnant (FLR) Hypertrophy

TypeinterventionalSponsorMaastricht UniversityRan2020 to 2023Enrolled111ConditionsColorectal Cancer Liver MetastasesArmsPortal and Hepatic Vein Embolization
3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Article
  5. Article
  6. Article
  7. Review
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

86 authors.

Remon KorenblikDepartment of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
Sinéad JamesDepartment of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
Jens SmitsDepartment of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
Rafael Díaz-NietoDepartment of Liver Surgery, Liverpool University Hospitals NHS, Lower Ln, Fazakerley, Liverpool, L9 7AL, UK.
Rob DavisDepartment of Interventional Radiology, Liverpool University Hospitals NHS, Lower Ln, Fazakerley, Liverpool, L9 7AL, UK.
Benjamin K Y ChanDepartment of Liver Surgery, Liverpool University Hospitals NHS, Lower Ln, Fazakerley, Liverpool, L9 7AL, UK.
Joris I ErdmannDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
IJsbrand A J ZijlstraDepartment of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
Pieter J W ArntzDepartment of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
Otto KollmarDepartment of Surgery, Clarunis University Hospital, Surgery, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
Martin H HoffmannDepartment of Radiology, St. Claraspital, Kleinriehenstrasse 30, 4058, Basel, Switzerland.
David G VassDepartment of Surgery, Belfast Health & Social Care Trust, 51 Lisburn Rd, Belfast, BT9 7AB, UK.
Richard LindsayDepartment of Interventional Radiology, Belfast Health & Social Care Trust, 51 Lisburn Rd, Belfast, BT9 7AB, UK.
Matteo SerenariHepato-biliary and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, BO, Italy.
Alberto CappelliDepartment of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Zamboni, 33, 40126, Bologna, BO, Italy.
Paul D GobardhanDepartment of Surgery, Amphia, Molengracht 21, 4818 CK, Breda, the Netherlands.
Farshad ImaniDepartment of Radiology, Amphia Molengracht 21, 4818 CK, Breda, the Netherlands.
Yiliam Fundora SuarezDepartment of Surgery, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
Fernando Gómez MuñosDepartment of Radiology, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
Dirk J GrünhagenDepartment of Surgery, Erasmus Medisch Centrum, Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
Adriaan MoelkerDepartment of Radiology and Nuclear Medicine, Erasmus MC, Erasmus University, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
Kay J PietermanDepartment of Radiology and Nuclear Medicine, Erasmus MC, Erasmus University, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
Jörg KleeffDepartment of Surgery, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany.
Walter A WohlgemuthDepartment of Radiology, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany.
Eric HerreroDepartment of Surgery, University Hospital Mútua Terrassa, Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
Arantxa GelabertDepartment of Radiology, Hospital Parc Taulí de Sabadell, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.
Stefan BreitensteinDepartment of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland.
Nico SeegerDepartment of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland.
Olivier DetryDepartment of Abdominal Surgery and Transplantation, University of Liege, CHU Liege, Liege, Avenue de l'Hôpital 1, 4000, Liège, Belgium.
Laurent GerardDepartment of Radiology, CHU Liege, Liege, Avenue de l'Hôpital 1, 4000, Liège, Belgium.
Per A SandströmDepartment of Surgery, Linköping University Hospital, Universitetssjukhuset, 581 85, Linköping, Sweden.
Bergthor BjörnssonDepartment of Surgery, Linköping University Hospital, Universitetssjukhuset, 581 85, Linköping, Sweden.
Luca A AldrighettiDepartment of Surgery, Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
Francesco De CobelliDepartment of Radiology, Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
Wouter K G LeclercqDepartment of Surgery, Máxima Medisch Centrum, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
Laurens J van BaardewijkDepartment of Radiology, Máxima Medisch Centrum, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
Daniel CroaghDepartment of Surgery, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia.
Diederick W De BooDepartment of Radiology, Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia.
T Peter KinghamDepartment of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
Fourat RidouaniDepartment of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
Peter MetrakosDepartment of Surgery, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
David ValentiDepartment of Radiology, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
Jennifer KalilDepartment of Surgery, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
Åsmund A FretlandDepartment of Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
Ulrik CarlingDepartment of Radiology, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
Guillaume MartelDepartment of Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
Stephen RyanDepartment of Radiology, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
Venkatesha UdupaDepartment of HPB Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK.
Andrew MacdonaldDepartment of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK.
Jordan C TasseDepartment of Interventional Radiology, Rush University Medical Center, 1620 W Harrison St, Chicago, IL, 60612, USA.
Gregor A StavrouDepartment of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbruecken, Winterberg 1, 66119, Saarbrücken, Germany.
Elmar SpuentrupInstitute for Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Saarbruecken, Winterberg 1, 66119, Saarbrücken, Germany.
Francisco G BorobiaDepartment of Surgery, Hospital Parc Taulí de Sabadell, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.
Eva CriadoInterventional Radiology Unit, UDIAT-Centre Diagnòstic, Hospital Universitario Parc Tauli Sabadell, Medicine Department Universidad Autónoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Barcelona, Spain.
Ernesto SparrelidDivision of Surgery and Oncology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Nobels väg 6, 171 77, Stockholm, Sweden.
Martin DelleDivision of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Nobels väg 6, 171 77, Stockholm, Sweden.
Jordi Navinés-LópezDepartment of Surgery, University Hospital Germans Trias I Pujol, Ctra. de Canyet, s/n, 08916, Badalona, Barcelona, Spain.
Jaume Sampere MoraguesDepartment of Radiology, University Hospital Germans Trias I Pujol, Ctra. de Canyet, s/n, 08916, Badalona, Barcelona, Spain.
Esteban Cugat AndorràDepartment of Surgery, University Hospital Germans Trias I Pujol, Ctra. de Canyet, s/n, 08916, Badalona, Barcelona, Spain.
Andreas SchnitzbauerDepartment of Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Thomas J VoglDepartment of Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Jan HeilDepartment of Surgery, University of Ulm, Albert-Einstein-Allee 7, 89081, Ulm, Germany.
John N PrimroseUniversity Surgery, University Hospital Southampton NHS Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK.
Sachin ModiDepartment of Radiology, University Hospital Southampton NHS Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK.
Suomi M G FouraschenDepartment of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
Reinoud P H BokkersDepartment of Radiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
Marieke T de BoerDepartment of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
Inne H M Borel RinkesDepartment of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
Maarten L J SmitsDepartment of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
Thomas GruenbergerDepartment of Surgery, HPB Center, Clinic Favoriten, Health Network Vienna, Kundratstraße 3, 1100, Wien, Austria.
Ivan BaclijaDepartment of Radiology, Clinic Favoriten, Kundratstraße 3, 1100, Wien, Austria.
Kevin G BillingsleyDepartment of Surgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
David C MadoffDepartment of Radiology, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
Alejandro SerrabloDepartment of Surgery, University Hospital Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain.
Luis SarriáDepartment of Radiology, University Hospital Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain.
Xiaoying WangDepartment of Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Xuhui District, Shanghai, 200032, China.
Qu XudongDepartment of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Xuhui District, Shanghai, 200032, China.
Bjorn WinkensDepartment of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
Steven W L Olde DaminkDepartment of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
Marc H A BemelmansDepartment of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
Maxime J L DewulfDepartment of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
Christoph A BinkertClinic of Interventional Radiology and Vascular Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland.
Erik SchaddeDepartment of Surgery, Rush University Medical Center, 1620 W Harrison St, Chicago, IL, 60612, USA.
Christiaan van der LeijGROW School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands.
Ronald M van DamDepartment of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
DRAGON collaborative study group

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI SELWYN M VICKERS · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

Background: Major liver resection is often required for complete clearance of colorectal liver metastases (CRLM). Patients with insufficient future liver remnant (FLR) volume/function are at high risk of post-hepatectomy liver failure (PHLF) and require FLR hypertrophy-inducing procedures to enable safe resection. The most recent variant of these procedures is combined portal and hepatic vein embolization (PVE/HVE). The DRAGON 1 trial evaluates the safety and efficacy of PVE/HVE, while assessing recruitment potential for the DRAGON 2 randomized trial. Methods: DRAGON 1 is a prospective, single-arm, international, multicenter trial. Patients with upfront unresectable CRLM due to a small FLR were included. The primary outcome was the ability of centers to recruit three patients and perform PVE/HVE and liver resection without 90-day mortality. Secondary outcomes included recruitment capacity, PVE/HVE technical details, FLR volume changes, complications, and resection rates. The study is registered at ClinicalTrials.gov, identifier: NCT04272931. Findings: In total, 102 patients were included from 43 centers. Twenty-four centers (24/43 = 56%) recruited three or more patients, and 20 centers (20/43 = 47%) achieved this without 90-day mortality. Of 96 patients undergoing PVE/HVE, no post-embolization mortality occurred, though major complications were reported in two patients. Resection was completed in 86 patients (86/96 = 90%), with seven patients (7/86 = 8%) dying within 90 days. PHLF grade B/C (International Study Group of Liver Surgery criteria) occurred in 19 patients (19/86 = 22%). Interpretation: DRAGON 1 demonstrates that PVE/HVE is safe, with no embolization-related mortality, low morbidity, and high resection rates in upfront unresectable CRLM. Funding: The Dutch Cancer Society, National Institute for Health and Care Research UK, Maastricht UMC+, Abbott Laboratories and Guerbet.

Indexed as

Bilobar colorectal liver metastasesColorectal liver metastasesDRAGON 1 trialEmbolization techniquesExtended liver resectionFLR hypertrophyFuture liver remnantHepatic regenerationHepatic vein embolizationKinetic growth rateLiver resectionLiver surgery complicationsLiver venous deprivationMulticenter clinical trialPortal vein embolizationPost-hepatectomy liver failurePreoperative liver augmentationRegenerative liver proceduresResection ratesSurgical oncology

Identifiers

PMID40255933
PMCPMC12008670

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.