Surgical Methods for Liver Failure Prevention after Advanced Hepatectomies

Abstract

Aim. To compare different surgical methods for liver failure prevention after major hepatectomies with small future liver remnant. Material and Methods. For prevention of post-resection liver failure, different variants of two-stage procedures were applied in 31 pts with small future liver remnant. The following methods were used: portal vein embolization with subsequent major hepatectomy (23), ALPPS (1), minimally invasive variants of ALPPS with partial radio-frequency destruction of the liver parenchyma in the plane of the future resection without separation of the parenchyma (RALPPS) and portal vein embolization (5), right portal vein ligation (2). Results. ALPPS led to hypertrophy rate of the future remnant liver of 71%, however, due to severe complications and fatal outcome method was not used further. Intervals to achieve hypertrophy of the future liver remnant after first stage of RALPPS and portal vein embolization were 14 and 29 days respectively (p 0.05). Nevertheless, tumor progression did not influence the rate of complete resection (completeness of the second stage) in RALPPS (100%) in contrast to portal vein embolization (70%). Liver failure according to ISGLS criteria was revealed in 7 (26%) pts including 5 (22%) pts after portal vein embolization (grade А, В), 1 patient after ALPPS (grade С), 1 (14%) patient after RALPPS (grade В) without significant differences (p > 0.05). Conclusion. Minimally invasive variants of ALPPS can lead to lower rate of morbidity comparable with two-stage hepatectomies with the same high rate and short term hypertrophy as for classical ALPPS.