How should liver hypertrophy be stimulated? A comparison of upfront associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and portal vein embolization (PVE) with rescue possibility.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)
colorectal liver metastases (CRLM)
liver surgery
portal vein embolization (PVE)
Journal
Hepatobiliary surgery and nutrition
ISSN: 2304-3881
Titre abrégé: Hepatobiliary Surg Nutr
Pays: China (Republic : 1949- )
ID NLM: 101600750
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
04
08
2019
accepted:
08
10
2019
entrez:
12
2
2021
pubmed:
13
2
2021
medline:
13
2
2021
Statut:
ppublish
Résumé
The role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in comparison to portal vein embolization (PVE) is debated. The aim of this study was to compare successful resection rates (RR) with upfront ALPPS A retrospective analysis of all patients treated with PVE for colorectal liver metastasis (CRLM) or ALPPS (any diagnosis, rescue ALPPS included) at five Scandinavian university hospitals during the years 2013-2016 was conducted. A Chi-square test and a Mann-Whitney U test were used to assess the difference between the groups. A successful RR was defined as liver resection without a 90-day mortality. A total of 189 patients were included. Successful RR was in 84.5% of the patients with ALPPS upfront and in 73.3% of the patients with PVE and rescue ALPPS on demand (P=0.080). The hypertrophy of the future liver remnants (FLRs) with ALPPS upfront was 71% (48-97%) compared to 96% (82-113%) after PVE and rescue ALPPS (P=0.010). Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on demand. The sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.
Sections du résumé
BACKGROUND
BACKGROUND
The role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in comparison to portal vein embolization (PVE) is debated. The aim of this study was to compare successful resection rates (RR) with upfront ALPPS
METHODS
METHODS
A retrospective analysis of all patients treated with PVE for colorectal liver metastasis (CRLM) or ALPPS (any diagnosis, rescue ALPPS included) at five Scandinavian university hospitals during the years 2013-2016 was conducted. A Chi-square test and a Mann-Whitney U test were used to assess the difference between the groups. A successful RR was defined as liver resection without a 90-day mortality.
RESULTS
RESULTS
A total of 189 patients were included. Successful RR was in 84.5% of the patients with ALPPS upfront and in 73.3% of the patients with PVE and rescue ALPPS on demand (P=0.080). The hypertrophy of the future liver remnants (FLRs) with ALPPS upfront was 71% (48-97%) compared to 96% (82-113%) after PVE and rescue ALPPS (P=0.010).
CONCLUSIONS
CONCLUSIONS
Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on demand. The sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.
Identifiants
pubmed: 33575285
doi: 10.21037/hbsn.2019.10.36
pii: hbsn-10-01-1
pmc: PMC7867725
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1-8Commentaires et corrections
Type : CommentIn
Informations de copyright
2021 Hepatobiliary Surgery and Nutrition. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure from (available at http://dx.doi.org/10.21037/hbsn.2019.10.36). The authors have no conflicts of interest to declare.
Références
Z Gastroenterol. 2014 Jan;52(1):35-42
pubmed: 24420797
World J Hepatol. 2019 Jun 27;11(6):513-521
pubmed: 31293719
HPB (Oxford). 2017 May;19(5):396-405
pubmed: 28343889
Ann Surg Oncol. 2006 Oct;13(10):1261-8
pubmed: 16947009
HPB (Oxford). 2019 Aug;21(8):1017-1023
pubmed: 30765198
Langenbecks Arch Surg. 2017 Feb;402(1):69-75
pubmed: 27761713
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
World J Surg. 2014 Jun;38(6):1510-9
pubmed: 24748319
Ann Surg. 2017 Nov;266(5):779-786
pubmed: 28806301
Scand J Surg. 2016 Sep;105(3):158-62
pubmed: 26929296
Ann Surg Oncol. 2016 Apr;23(4):1335-43
pubmed: 26646946
HPB (Oxford). 2017 Dec;19(12):1126-1129
pubmed: 28917644
Surgery. 2017 Feb;161(2):453-464
pubmed: 27814957
Case Rep Surg. 2013;2013:238675
pubmed: 24383035
Ann Surg. 2018 May;267(5):833-840
pubmed: 28902669
J Gastrointest Surg. 2019 Mar;23(3):556-562
pubmed: 30465187
Ann Surg. 2012 Mar;255(3):405-14
pubmed: 22330038
HPB (Oxford). 2013 Jul;15(7):483-91
pubmed: 23750490
Surgery. 2016 May;159(5):1279-86
pubmed: 26606881
Eur J Surg Oncol. 2016 Apr;42(4):531-7
pubmed: 26830731
J Am Coll Surg. 2013 Feb;216(2):201-9
pubmed: 23219349
Liver Transpl. 2002 Mar;8(3):233-40
pubmed: 11910568
Ann Surg. 2014 Nov;260(5):829-36; discussion 836-8
pubmed: 25379854