Division of HPB Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.
Am Surg. 2021 Feb;87(2):309-315. doi: 10.1177/0003134820950687. Epub 2020 Sep 16.
Resection with trisectionectomy may necessitate liver molding for adequate future liver remnant (FLR), and subsequent complications can impact return to intended oncologic therapy (RIOT). This study evaluated whether a difference in RIOT exists with the use of molding and between liver molding techniques (associating liver partition and portal vein ligation for staged hepatectomy [ALPPS] and portal vein embolization [PVE]) with trisectionectomy.
A retrospective review evaluated trisectionectomies for malignancy. Outcomes were compared with and without molding, and RIOT was determined.
Fifty-one patients underwent trisectionectomy: 11 ALPPS, 14 PVE, 26 without molding. 73% of ALPPS, 64% of PVE, and 58% without molding achieved RIOT ( = .971). There were no differences found in baseline characteristics, R0 rate, length of stay, readmission, complications, or mortality. Time to RIOT was significantly different (ALPPS: 3.3 months; PVE: 5.2 months; none: 2.4 months, = .0203). There were no differences in recurrence or survival.
Liver molding should not cause apprehension as there are no differences in achieving RIOT. Although technique alters time to RIOT, this does not translate into improved outcomes, implicating disease biology, and regeneration stimulus.
三段式肝切除术可能需要进行肝脏塑形以获得足够的剩余肝（FLR），随后的并发症可能会影响肿瘤患者的回归意向治疗（RIOT）。本研究评估了在三段式肝切除术中使用塑形和不同的塑形技术（联合肝脏离断和门静脉结扎分阶段肝切除术[ALPPS]和门静脉栓塞术[PVE]）是否会对 RIOT 产生影响。
回顾性分析了因恶性肿瘤而行三段式肝切除术的病例。比较了有无塑形的患者的结果，并确定了 RIOT。
51 例患者接受了三段式肝切除术：11 例 ALPPS，14 例 PVE，26 例未行塑形。73%的 ALPPS、64%的 PVE 和 58%的未塑形患者实现了 RIOT（=.971）。三组患者在基线特征、R0 率、住院时间、再入院率、并发症或死亡率方面均无差异。RIOT 的时间有显著差异（ALPPS：3.3 个月；PVE：5.2 个月；未塑形：2.4 个月，=.0203）。三组患者在复发率和生存率方面无差异。
进行肝脏塑形不应引起担忧，因为在实现 RIOT 方面没有差异。尽管技术会改变 RIOT 的时间，但这并不会转化为更好的结果，提示疾病的生物学和再生刺激因素起作用。
