1. How much liver needs to be transected in ALPPS? A translational study investigating the concept of less invasiveness.
- Author
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Linecker M, Kambakamba P, Reiner CS, Linh Nguyen-Kim TD, Stavrou GA, Jenner RM, Oldhafer KJ, Björnsson B, Schlegel A, Györi G, Schneider MA, Lesurtel M, Clavien PA, and Petrowsky H
- Subjects
- Adult, Aged, Animals, Cohort Studies, Disease Models, Animal, Disease-Free Survival, Female, Hepatectomy mortality, Humans, Ligation methods, Liver Neoplasms mortality, Magnetic Resonance Imaging methods, Male, Mice, Middle Aged, Minimally Invasive Surgical Procedures methods, Minimally Invasive Surgical Procedures mortality, Neoplasm Invasiveness pathology, Neoplasm Staging, Organ Size, Patient Selection, Prognosis, Prospective Studies, Risk Assessment, Survival Rate, Tomography, X-Ray Computed methods, Translational Research, Biomedical, Treatment Outcome, Hepatectomy methods, Imaging, Three-Dimensional, Liver surgery, Liver Neoplasms diagnostic imaging, Liver Neoplasms surgery, Portal Vein surgery
- Abstract
Background: ALPPS induces rapid liver hypertrophy after stage-1 operation, enabling safe, extended resections (stage-2) after a short period. Recent studies have suggested that partial transection at stage-1 might be associated with a better safety profile. The aim of this study was to assess the amount of liver parenchyma that needs to be divided to achieve sufficient liver hypertrophy in ALPPS., Methods: In a bi-institutional, prospective cohort study, nonfibrotic patients who underwent ALPPS with complete (n = 22) or partial (n = 23) transection for colorectal liver metastases were analyzed and compared with an external ALPPS cohort (n = 23). A radiologic tool was developed to quantify the amount of parenchymal transection. Liver hypertrophy and clinical outcome were compared between both techniques. The relationship of partial transection and hypertrophy was investigated further in an experimental murine model of partial ALPPS., Result: The median amount of parenchymal transection in partial ALPPS was 61% (range, 34-86%). The radiologic method correlated poorly with the intraoperative surgeon's estimation (r
S = 0.258). Liver hypertrophy was equivalent for the partial ALPPS, ALPPS, and external ALPPS cohort (64% vs 60% vs. 64%). Experimental data demonstrated that partial transection of at least 50% induced comparable hypertrophy (137% vs 156%) and hepatocyte proliferation compared to complete transection., Conclusion: The study provides clinical and experimental evidence that partial liver partition of at least 50% seems to be equally effective in triggering volume hypertrophy as observed with complete transection and can be re recommended as less invasive alternative to ALPPS., (Copyright © 2016 Elsevier Inc. All rights reserved.)- Published
- 2017
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