Liver venous deprivation versus associating liver partition and portal vein ligation for staged hepatectomy for colo-rectal liver metastases: a comparison of early and late kinetic growth rates,and perioperative and oncological outcomes |
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| Institution: | 1. Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, “Federico II” University, Naples, Italy;2. Department of Digestive Surgery and Liver Transplantation, University of Montpellier, France;3. Department of Surgical Oncology, Institut du Cancer de Montpellier - ICM, University of Montpellier, Montpellier, France;4. General and Emergency Surgery Unit, GB Grassi Hospital, Rome, Italy;5. Department of Radiology, Montpellier University Hospital, France;1. Department of Thoracic Surgery, National Hospital Organization Yamaguchi Ube Medical Center, 685 Higashikiwa Ube, Yamaguchi, 755-0241, Japan;2. Clinical Research, National Hospital Organization Yamaguchi Ube Medical Center, 685 Higashikiwa Ube, Yamaguchi, 755-0241, Japan;3. Department of Pathology, KYURIN/ KYURIN PACELL Corporation, 26-67 Morishita-cho, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-0046, Japan;4. Department of Pathology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan;1. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, South Korea;1. Division of Hepatobiliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine Kyoto University, Kyoto, Japan;2. Department of Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan |
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| Abstract: | BackgroundDifferent techniques have been developed to optimize the Future Liver Remnant (FLR). Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) have shown the higher hypertrophy rates, but their place in clinical practice is still debated.MethodsThirty-two consecutive ALPPS and LVD procedures for CRLM performed between December 2015 and December 2019 were included. This retrospective study evaluated kinetic growth rates (KGR) as primary outcome, and perioperative and oncological outcomes as secondary endpoints.ResultsA total of 17 patients underwent LVD before surgery, whereas 15 underwent ALPPS. On early evaluation (7 vs 9 days, respectively), KGR did not differ between ALPPS and LVD cohort (0.8% per day vs 0.3% per day, p = 0.70; 23 cc/day vs 26 cc/day, p = 0.31). Late evaluation (21 vs 9 days) showed a KGR significantly decreased in the LVD group (0.6% per day vs 0.2% per day, p = 0.21; 20 cc/day vs 10 cc/day p = 0.02). Mean FLR-V increase was comparable in the two groups (60% vs 49%, p 0.32). Successful resection rate was 100% and 94% in LVD and ALPPS group, respectively. The hospital stay (p < 0.0001) and severe complications rate (p = 0.05) were lower after LVD. One and 3-years overall survival (OS) were 72,7% and 27,4% in the ALPSS group, versus 81,3% and 54,7% in LVD group (p = 0.10). The Median DFS was comparable between both techniques (6.1 months and 5.9 respectively, p = 0.66).ConclusionsLVD and ALPPS shows similar KGR during the early period following preparation as well as similar survival outcomes. Hospital stay and severe complications are lower after LVD. |
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| Keywords: | Liver Venous Deprivation ALPPS Associated liver partition and portal vein ligation for staged hepatectomy major hepatectomy liver surgery outcomes |
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