Liver Venous Deprivation or Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy?: A Retrospective Multicentric Study.

Autor:	Chebaro A; Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille, France., Buc E; Department of Digestive Pathology, Surgery Unit, CHU Clermont Ferrand Hôtel Dieu NHE, Clermont Ferrand, France., Durin T; Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille, France., Chiche L; Department of Hepatobiliary Surgery, Haut Lévêque Hospital, CHU Bordeaux, Bordeaux, France., Brustia R; Department of Digestive and Hepato-Pancreatic-Biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France., Didier A; Department of HPB Surgery, Nancy University Hospital, Nancy, France., Pruvot FR; Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille, France., Kitano Y; AP-HP Hôpital Paul Brousse, Centre Hépatobiliaire, Université Paris Saclay, Villejuif, France.; Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan., Muscari F; Digestive Surgery Unit, University Hospital Rangueil, Toulouse, France., Lecolle K; Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille, France., Sulpice L; Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France., Sonmez E; AP-HP Hôpital Paul Brousse, Centre Hépatobiliaire, Université Paris Saclay, Villejuif, France., Bougard M; Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France., El Amrani M; Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille, France.; CANTHER Laboratory 'Cancer Heterogeneity, Plasticity and Resistance to Therapies' UMR-S1277, Team 'Mucins, Cancer and Drug Resistance', Lille, France., Sommacale D; Department of Digestive and Hepato-Pancreatic-Biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France., Maulat C; Digestive Surgery Unit, University Hospital Rangueil, Toulouse, France., Ayav A; Department of HPB Surgery, Nancy University Hospital, Nancy, France., Adam R; AP-HP Hôpital Paul Brousse, Centre Hépatobiliaire, Université Paris Saclay, Villejuif, France., Laurent C; Department of Hepatobiliary Surgery, Haut Lévêque Hospital, CHU Bordeaux, Bordeaux, France., Truant S; Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, Lille, France.; CANTHER Laboratory 'Cancer Heterogeneity, Plasticity and Resistance to Therapies' UMR-S1277, Team 'Mucins, Cancer and Drug Resistance', Lille, France.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2021 Nov 01; Vol. 274 (5), pp. 874-880.
DOI:	10.1097/SLA.0000000000005121
Abstrakt:	Objective: To compare 2 techniques of remnant liver hypertrophy in candidates for extended hepatectomy: radiological simultaneous portal vein embolization and hepatic vein embolization (HVE); namely LVD, and ALPPS. Background: Recent advances in chemotherapy and surgical techniques have widened indications for extended hepatectomy, before which remnant liver augmentation is mandatory. ALPPS and LVD typically show higher hypertrophy rates than portal vein embolization, but their respective places in patient management remain unclear. Methods: All consecutive ALPPS and LVD procedures performed in 8 French centers between 2011 and 2020 were included. The main endpoint was the successful resection rate (resection rate without 90-day mortality) analyzed according to an intention-to-treat principle. Secondary endpoints were hypertrophy rates, intra and postoperative outcomes. Results: Among 209 patients, 124 had LVD 37 [13,1015] days before surgery, whereas 85 underwent ALPPS with an inter-stages period of 10 [6, 69] days. ALPPS was mostly-performed for colorectal liver metastases (CRLM), LVD for CRLM and perihilar cholangiocarcinoma. Hypertrophy was faster for ALPPS. Successful resection rates were 72.6% for LVD ± rescue ALPPS (n = 6) versus 90.6% for ALPPS (P < 0.001). Operative duration, blood losses and length-of-stay were lower for LVD, whereas 90-day major complications and mortality were comparable. Results were globally unchanged for CRLM patients, or after excluding the early 2 years of experience (learning-curve effect). Conclusions: This study is the first 1 comparing LVD versus ALPPS in the largest cohort so far. Despite its retrospective design, it yields original results that may serve as the basis for a prospective study. Competing Interests: The authors report no conflicts of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu