Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, "Federico II" University, Naples, Italy.
Department of Digestive Surgery and Liver Transplantation, University of Montpellier, France.
Surg Oncol. 2022 Aug;43:101812. doi: 10.1016/j.suronc.2022.101812. Epub 2022 Jul 7.
Different 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.
Thirty-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.
A 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).
LVD 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.
已经开发出不同的技术来优化未来肝残留（FLR）。联合肝脏分割和门静脉结扎分期肝切除术（ALPPS）和肝静脉阻断（LVD）显示出更高的肝再生率，但它们在临床实践中的地位仍存在争议。
纳入 2015 年 12 月至 2019 年 12 月期间进行的 32 例连续的结直肠癌肝转移（CRLM）患者接受 ALPPS 和 LVD 治疗。本回顾性研究评估了动力学生长率（KGR）作为主要结局，以及围手术期和肿瘤学结局作为次要结局。
共有 17 例患者在术前接受了 LVD，而 15 例患者接受了 ALPPS。在早期评估（分别为 7 天和 9 天）时，ALPPS 和 LVD 组的 KGR 没有差异（分别为 0.8%/天和 0.3%/天，p=0.70；分别为 23cc/天和 26cc/天，p=0.31）。晚期评估（21 天和 9 天）显示 LVD 组的 KGR 显著下降（分别为 0.6%/天和 0.2%/天，p=0.21；分别为 20cc/天和 10cc/天，p=0.02）。两组的 FLR-V 增加均值相似（分别为 60%和 49%，p=0.32）。LVD 和 ALPPS 组的成功切除率分别为 100%和 94%。LVD 后住院时间（p<0.0001）和严重并发症发生率（p=0.05）较低。ALPSS 组的 1 年和 3 年总生存率（OS）分别为 72.7%和 27.4%，LVD 组分别为 81.3%和 54.7%（p=0.10）。两种技术的中位 DFS 相似（分别为 6.1 个月和 5.9 个月，p=0.66）。
LVD 和 ALPPS 在准备后的早期阶段显示出相似的 KGR 和相似的生存结果。LVD 后住院时间和严重并发症发生率较低。
