Portal Vein Embolization and ALPPS for Prevention of Post-Hepatectomy Liver Failure

A E Shcherba,D I Yurlevich,O O Rummo,D Yu Efimov,L V Kirkovsky

doi:10.16931/1995-5464.2016356-63

A E Shcherba, D I Yurlevich + Show 3 more

Open Access

https://doi.org/10.16931/1995-5464.2016356-63

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Abstract

Aim. To estimate early and remote outcomes of portal vein embolization and ALPPS for prevention of post-hepatectomy liver failure. Material and Methods. 358 liver resections were performed for the period 2008–2016. There were 132 (36.9%) advanced resections (over 4 segments). Cholangiocelullar carcinoma was diagnosed in 48 cases (36.4%), hepatocellular carcinoma – in 23 (17.4%) cases, colorectal liver metastases – in 19 (14.4%), parasitic liver diseases (hydatid disease, alveococcosis) – in 31 (23.5%) cases and others – in 11 (8.3%) cases. Vascular resection was performed in 42 (31.8%) patients, common bile and (or) common hepatic duct resection – in 76 (57.6%) cases. In this article 41 cases of portal vein embolization with staged liver resection and 6 cases of ALPPS are described. Control group included 85 advanced liver resections without portal vein embolization. Results. Portal vein embolization was effective in 41 (66%) cases: FLR growth was 52% (33;61) within average terms of 5.0 (4.0; 6.5) weeks. In ALPPS FLR growth was 70% (60; 77) after 11 (7; 17) days, in 1 case it was uneffective (FLR% – 30% after 24 days). The grade B+C of post hepatectomy liver failure was observed in 66 (50%) cases, infectious complications – in 39 (29.5%) cases, biliary complications – in 29 (21.9%) cases, post hepatectomy bleeding (grade C, ISGLS) – in 5 (3,8%) cases. In-hospital mortality was 8,3 %. Portal vein embolization decreased grade C post hepatectomy liver failure (7.3% vs 20%) (p = 0.07). Conclusion. Two-stage liver resection with primary embolization or ligation of the portal vein can reduce the frequency of post-resection liver failure. For certain patients ALPPS is the only method that allows to perform radical surgery and preserve necessary amount of hepatic parenchyma. However long-term results are unpredictable

Highlights

Republican Research and Practical Center for Organ and Tissue Transplantation, 9th City Clinical Hospital; 8, Semashko str., Minsk, 220045, the Republic of Belarus
Two-stage liver resection with primary embolization or ligation of the portal vein can reduce the frequency of post-resection liver failure
Для определенной группы пациентов ALPPS является единственным способом хирургического вмешательства, позволяющим выполнить радикальную операцию и сохранить необходимый объем печеночной паренхимы, но с непредсказуемыми отдаленными результатами

Summary

Introduction

Republican Research and Practical Center for Organ and Tissue Transplantation, 9th City Clinical Hospital; 8, Semashko str., Minsk, 220045, the Republic of Belarus. Были внедрены в практику двухэтапные операции: первым этапом выполняли лигирование (ЛВВ) или эмболизацию ветви воротной вены (ЭВВ), вторым – резекцию печени [8, 9]. Гемодинамические изменения и перераспределение регенераторных стимулов при лигировании и (или) эмболизации ветви воротной вены приводили к гипертрофии неокклюзированной доли печени, что позволяло увеличить остаточный объем.

Results

Conclusion