ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis
| Autor: | Hauke Lang, Roberto Hernandez-Alejandro, Kris P. Croome, Victoria Ardiles, Christoph Tschuor, J. Baumgart, Nadja Amacker, Eduardo de Santibaňes, Erik Schadde, Pierre-Alain Clavien, Gregory Sergeant, Ksenija Slankamenac |
|---|---|
| Přispěvatelé: | University of Zurich |
| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
10042 Clinic for Diagnostic and Interventional Radiology business.industry medicine.medical_treatment 610 Medicine & health 030230 surgery Vascular surgery 2746 Surgery 3. Good health Cardiac surgery Surgery 03 medical and health sciences 0302 clinical medicine Cardiothoracic surgery 030220 oncology & carcinogenesis Occlusion medicine Embolization Hepatectomy Ligation business 10217 Clinic for Visceral and Transplantation Surgery Abdominal surgery |
| Zdroj: | World journal of surgery WORLD JOURNAL OF SURGERY |
| DOI: | 10.1007/s00268-014-2513-3 |
| Popis: | Background: Portal vein occlusion to increase the size of the future liver remnant (FLR) is well established, using portal vein ligation (PVL) or embolization (PVE) followed by resection 4-8weeks later. Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) combines PVL and complete parenchymal transection, followed by hepatectomy within 1-2weeks. ALPPS has been recently introduced but remains controversial. We compare the ability of ALPPS versus PVE or PVL for complete tumor resection. Methods: A retrospective review of all patients undergoing ALPPS or conventional staged hepatectomies using PVL or PVE at four high-volume HPB centres between 2003 and 2012 was performed. Patients with primary liver tumors and liver metastases were included. Primary endpoint was complete tumor resection. Secondary endpoints include 90-day mortality, complications, FLR increase, time to resection, and tumor recurrence. Results: Forty-eight patients with ALPPS were compared with 83 patients with conventional-staged hepatectomies. Eighty-three percent (40/48 patients) of ALPPS patients achieved complete resection compared with 66% (55/83 patients) in PVE/PVL (odds ratio 3.34, p=0.027). Ninety-day mortality in ALPPS and PVE/PVL was 15 and 6%, respectively (p=0.2). Extrapolated growth rate was 11 times higher in ALPPS (34.8cc/day; interquartile range (IQR) 26-49) compared with PVE/PVL (3cc/day; IQR2-6; p=0.001). Tumor recurrence at 1year was 54 versus 52% for ALPPS and PVE/PVL, respectively (p=0.7). Conclusions: This study provides evidence that ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors at the cost of a high mortality. The technique is promising but should currently not be used outside of studies and registries. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|