Virgen de la Arrixaca Clinic and University Hospital, Departament of Surgery and Transplantation, IMIB-Arrixaca, Murcia, Spain.
Department of Surgery and Transplantation, University Medical Center Schleswig-Holstein, Campus Kiel, Germany.
Liver Int. 2022 Dec;42(12):2815-2829. doi: 10.1111/liv.15287. Epub 2022 May 26.
While ALPPS triggers a fast liver hypertrophy, it is still unclear which factors matter most to achieve accelerated hypertrophy within a short period of time. The aim of the study was to identify patient-intrinsic factors related to the growth of the future liver remnant (FLR).
This cohort study is composed of data derived from the International ALPPS Registry from November 2011 and October 2018. We analyse the influence of demographic, tumour type and perioperative data on the growth of the FLR. The volume of the FLR was calculated in millilitre and percentage using computed-tomography (CT) scans before and after stage 1, both according to Vauthey formula.
A total of 734 patients were included from 99 centres. The median sFLR at stage 1 and stage 2 was 0.23 (IQR, 0.18-0.28) and 0.39 (IQR: 0.31-0.46), respectively. The variables associated with a lower increase from sFLR1 to sFLR2 were age˃68 years (p = .02), height ˃1.76 m (p ˂ .01), weight ˃83 kg (p ˂ .01), BMI˃28 (p ˂ .01), male gender (p ˂ .01), antihypertensive therapy (p ˂ .01), operation time ˃370 minutes (p ˂ .01) and hospital stay˃14 days (p ˂ .01). The time required to reach sufficient volume for stage 2, male gender accounts 40.3% in group ˂7 days, compared with 50% of female, and female present 15.3% in group ˃14 days compared with 20.6% of male.
Height, weight, FLR size and gender could be the variables that most constantly influence both daily growths, the interstage increase and the standardized FLR before the second stage.
尽管联合肝脏离断和门静脉结扎的分阶段肝切除术（ALPPS）可引发快速肝增生，但仍不清楚哪些因素对在短时间内实现加速肝增生最重要。本研究旨在确定与未来肝残存量（FLR）生长相关的患者内在因素。
本队列研究由 2011 年 11 月至 2018 年 10 月期间国际 ALPPS 注册中心的数据组成。我们分析了人口统计学、肿瘤类型和围手术期数据对 FLR 生长的影响。使用 CT 扫描，根据 Vauthey 公式，在第一阶段前后分别以毫升和百分比计算 FLR 体积。
共纳入来自 99 个中心的 734 名患者。第一阶段和第二阶段的 sFLR 中位数分别为 0.23（IQR，0.18-0.28）和 0.39（IQR：0.31-0.46）。与 sFLR1 到 sFLR2 增加较低相关的变量包括年龄＞68 岁（p = 0.02）、身高＞1.76m（p ＜0.01）、体重＞83kg（p ＜0.01）、BMI＞28（p ＜0.01）、男性（p ＜0.01）、抗高血压治疗（p ＜0.01）、手术时间＞370 分钟（p ＜0.01）和住院时间＞14 天（p ＜0.01）。达到第二阶段所需的足够体积的时间，男性在＜7 天的组中占 40.3%，而女性占 50%；女性在＞14 天的组中占 15.3%，而男性占 20.6%。
身高、体重、FLR 大小和性别可能是最常影响每日生长、两个阶段之间的增长以及第二阶段前标准化 FLR 的变量。
