The Most Minimally-invasive ALPPS - Using Terminal Branches Portal Vein Embolization (TBPVE) for Liver Partition (A Report of 24 Cases)

Abstract

Introduction: Numerous modifications have been suggested for improvement of ALPPS. We suggest Terminal Branches Portal Vein Embolization (TBPVE) as a minimally-invasive way to partition the liver. The intra-hepatic portal vein communication can thus be blocked between both liver. As a result, only a single surgical operation is required. This method is termed Terminal branches portal vein Embolization Liver Partition Planned hepatectomy (TELPP). Methods: From February 2016 to November 2017, 24 patients were performed with TELPP. The procedure was that in addition to PVE, embolization agent was infused to the terminal branches of portal vein of S5, S8 or S4. In order to avoid potential enlargement of tumor, in some cases tumor TACE were used at the same time. Standard liver volume(SLV), future liver remnant (FLR) and FLR/SLV are calculated by CT scan taken. Open or laparoscopic hepatectomy was performed in two weeks when the FLR is appropriate. Results: All the patients (most of the liver were cirrhotic;4 patients with PVTT) achieved enough FLR that had a median increase of 55.6% (from 26.2% to 120.8%) in two weeks. All of them underwent hepatectomy, most of them were extended hemihepatectomy and trisegmentectomy. No server morbidity occurred except 1 case with minor ectopic thrombus. 3 patients died respectively 15,18,7 months, all the other 21 patients are surviving. Conclusion: This study shows that TBPVE had a rapid FLR increase similar to ALPPS without it's drawback. TELPP is very promising, cause requiring only one single operation instead of two staged operations.