Influence on the Kinetic Growth Rate after PVE and ALPPS

Abstract

Purpose: "Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy" (ALPPS) and "Portal Vein Embolization" (PVE) have an important role in the treatment of malignant liver tumors. Both procedures induce rapid and effective hypertrophy of the future liver remnant (FLR) to prevent postoperative liver failure. The aim of this study is to determine impact factors on the kinetic growth rate (KGR) and subsequently FLR, in terms of complications, posthepatectomy liver failure (PHLF) and survival. Method: Patients undergoing ALPPS and PVE from 2010 until 2020 were included. KGR was defined as the quotient of hypertrophy and the time interval in weeks between intervention (PVE/ALPPS step 1) and resection. Results: Overall, 90 patients underwent ALPPS and 82 patients received PVE. The association between KGR and PHLF indicates a significant nonlinear effect in PVE (p=0.009) and ALPPS (p=0.05). For ALPPS, the incidence of PHLF significantly decreased from 30% to 8% (p=0,032) at cutoff value of KGR of >7 %/week. Patients with a KGR of >7%/week had a higher preoperative skeletal muscle index (p=0,029), but the same body mass index (p=0,301). Tumor anemia showed an association with a reduction of KGR (p=0,159). However, the KGR had no effect on postoperative morbidity, mortality, and long-term survival. For patients undergoing PVE, no valuable cutoff value for KGR could be calculated for a reduction of PHLF. Furthermore, the KGR was not influenced by preoperative metabolic or laboratory values. Conclusion: A KGR >7%/week showed a reduction of PHLF after ALPPS, but did not influence the morbidity and mortality. Skeletal muscle index and tumor anemia could be adjustable preoperative parameters to improve the KGR for patients undergoing ALPPS. For PVE, the KGR seems to be stable and no influencing factors could be found.