Lang Sven A, Loss Martin, Benseler Volker, Glockzin Gabriel, Schlitt Hans J
Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany,
Langenbecks Arch Surg. 2015 Apr;400(3):361-9. doi: 10.1007/s00423-015-1285-z. Epub 2015 Feb 18.
In-situ split (ISS) liver resection is a novel method to induce rapid hypertrophy of the contralateral liver lobe in patients at risk for postoperative liver failure due to insufficient liver remnant. So far, no data about oncological long-term survival after ISS liver resection is available.
We retrospectively analyzed our patients treated with ISS liver resection at the Department of Surgery of the University of Regensburg, the first center worldwide to perform ISS.
Between 2007 and 2014, ISS liver resection was performed in 16 patients. Two patients (12.5 %) were lost in early postoperative phase (90 days) and one was lost to follow-up. Thirteen patients with a follow-up period of more than 3 months were included into oncologically focused analyses. Median follow-up was 26.4 months (range 3.2-54.6). Seven patients had suffered from colorectal liver metastases (CRLM) and six from various other liver malignancies (non-CRLM). The ISS procedure had led to a median increase of 86.3 % of the left lateral liver lobe after a median of 9 days (range 4-28 days). Median disease-free survival (DFS) was 14.6 months and median overall survival (OS) was 41.7 months (26.4 months when including 90-days mortality). Three-year survival was calculated with 56.4 and 48.9 % when including perioperative mortality, respectively (CRLM 64.3 % vs. non-CRLM 50 %).
ISS liver resection can provide long-term survival of selected patients with advanced liver malignancies that otherwise are not eligible for liver resection due to insufficient liver remnant.
原位劈裂（ISS）肝切除术是一种新方法，用于因剩余肝体积不足而有术后肝衰竭风险的患者，诱导对侧肝叶快速肥大。迄今为止，尚无关于ISS肝切除术后肿瘤学长期生存的数据。
我们回顾性分析了在雷根斯堡大学外科接受ISS肝切除术的患者，该中心是全球首个开展ISS手术的中心。
2007年至2014年期间，16例患者接受了ISS肝切除术。2例患者（12.5%）在术后早期（90天）死亡，1例失访。13例随访时间超过3个月的患者纳入肿瘤学重点分析。中位随访时间为26.4个月（范围3.2 - 54.6个月）。7例患者患有结直肠癌肝转移（CRLM），6例患有其他各种肝脏恶性肿瘤（非CRLM）。ISS手术后，中位9天（范围4 - 28天）后，左侧肝叶中位增加86.3%。中位无病生存期（DFS）为14.6个月，中位总生存期（OS）为41.7个月（包括90天死亡率时为26.4个月）。纳入围手术期死亡率时，三年生存率分别计算为56.4%和48.9%（CRLM为64.3%，非CRLM为50%）。
ISS肝切除术可为部分因剩余肝体积不足而原本不符合肝切除条件的晚期肝脏恶性肿瘤患者提供长期生存。
