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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

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Hepatobiliary Surgery and Nutrition 2021年第1期10卷 1-8页

作者： Ernesto Sparrelid Kristina Hasselgren Bård Ingvald Røsok Peter Nørgaard Larsen nicolai aagaard schultz Ulrik Carling Eva Fallentin Stefan Gilg Per Sandström Gert Lindell Bergthor Björnsson Department of Clinical Science Intervention and TechnologyDivision of SurgeryKarolinska InstituteKarolinska University HospitalStockholmSweden Department of Surgery and Clinical and Experimental Medicine Linköping UniversityLinköpingSweden Department of Hepato-Pancreato-Biliary Surgery Oslo University HospitalOsloNorway Department of Surgical Gastroenterology and Transplantation RigshospitaletUniversity of CopenhagenDenmark Department of Radiology and Nuclear Medicin RikshospitaletOslo University HospitalOsloNorway Department of Radiology RigshospitaletUniversity of CopenhagenCopenhagenDenmark Department of Surgery Skane University HospitalLundSweden

Background:The role of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)in comparison to portal vein embolization(PVE)is *** aim of this study was to compare successful resection rates(RR)with upfront ALPPS *** with rescue ALPPS on demand and to compare the hypertrophy of the liver between ALPPS and PVE plus subsequent rescue ***: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 ***:A total of 189 patients were *** 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:Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on *** sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.

关键词： Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) liver surgery colorectal liver metastases(CRLM) portal vein embolization(PVE)

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