Radiofrequency-assisted Liver Partition Research Articles

Immediate outcomes of percutaneous radiofrequency-assisted liver partition and portal vein embolization for staged hepatectomy (PRALPPS) in patients with intrahepatic cholangiocarcinoma (IHCC)

Surgical resection in intrahepatic cholangiocarcinoma (IHCC) is the only feasible modality with a curative ability. The challenge balances between growing the future liver remnant (FLR) in a short time and the same time preventing tumor progression and surgical complications. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) gives a chance for fast kinetic growth, but with high morbidity and mortality. This observation includes 8 comparative patients with IHCC: 4 underwent portal vein embolization (PVE) and 4, ALPPS (3, RALPPS). PVE group has median age 62.2 years, median FLR volume was 564.4 mL, 33%. ALPPS group has median age 58.6 years, median FLR volume was 542.6 mL, 34.9%. One patient had classic ALPPS and 3 had mini-invasive variant. The first stage was uncomplicated in the both groups. The median FLR volume became 785 mL (46%) in a 27.5 days and 753.9 mL (38%) in a 17.7 days in PVE and ALPPS groups respectively. Nevertheless, degree of hypertrophy was similar: 41% in PVE and 40.4% in ALPPS. Kinetic growth rate was significantly different: 1.38% and 2.62%/day, respectively. Seven patients completed the second stage. Sever morbidity was revealed with only ALPPS group: grade IIIa (n = 1) and grade V (n = 1) according to Clavien-Dindo. The in-hospital death was associated with classical ALPPS in one patient with extremely small FLR (< 30%). The modified ALPPS (PRALPPS) may be considered as a safe tool to achieve rapid and sufficient hypertrophy in patients with IHCC.

Outcomes of percutaneous radiofrequency-assisted liver partition and portal vein embolization for staged hepatectomy in patients with intrahepatic cholangiocarcinoma

Purpose: Surgical resection in intrahepatic cholangiocarcinoma (ICC) is the only feasible modality with a curative ability. The challenge balances between growing the future liver remnant (FLR) in a short time and the same time preventing tumor progression and surgical complications. Assotiated liver partition and portal vein embolization for stage hepatectomy (ALPPS) gives a chance for fast kinetic growth, but with high morbidity and mortality level. Methods: This observation includes 8 comparative patients with ICC: 4 underwent PVE and 4 - ALPPS (3 - PRALPPS). PVE group has median age 62,2 years, median FLR volume was 564,4 ml, 33%. ALPPS group has median age 58,6 years, median FLR volume was 542,6 ml, 34,9%. 1 patient had classic ALPPS and 3 had miniinvasive variant of ALPPS - percutaneous radiofrequency-assisted liver partition and portal vein embolization for staged hepatectomy (PRALPPS). Results: The first stage was uncomplicated in the both groups. The median FLR volume became 785 ml (46%) in a 27,5 days and 753,9 ml (38%) in a 17,7 days in PVE and ALPPS groups respectively. Nevertheless, degree of hypertrophy was similar: 41% in PVE and 40,4% in ALPPS. Kinetic growth rate was significantly different: 1,38 and 2,62%/day respectively. Seven patients completed the second stage. Sever morbidity was revealed with only ALPPS group: grade IIIa (n-1) and grade V (n-1) according to Clavien-Dindo. The in-hospital death was associated with classical ALPPS in one patient with extremely small FLR (<30%). Conclusions: The modified ALPPS (PRALPPS) may be considered as a safe tool to achieve rapid and sufficient hypertrophy in patients with ICC.

Percutaneous radiofrequency-assisted liver partition versus portal vein embolization before hepatectomy for perihilar cholangiocarcinoma.

BackgroundPercutaneous radiofrequency‐assisted liver partition with portal vein embolization in staged liver resection (PRALPPS) represents an alternative to portal vein embolization (PVE) followed by major liver resection in patients with perihilar cholangiocarcinoma.MethodsThis was an observational case–control study. Both procedures were applied in patients with a future liver remnant (FLR) volume of less than 40 per cent. The main end points of the study were short‐term morbidity and mortality for the two procedures. The study also compared the efficacy of the preresection phases estimated by kinetic growth rate (KGR), time interval and degree of hypertrophy of the FLR.ResultsThe first phase (preresection) was completed in 11 and 18 patients, and the second phase (resection) in nine and 14 patients, in the PRALPPS and PVE groups respectively. Major morbidity after the first stage did not differ between the groups. There were no differences in blood loss, severe morbidity or liver failure rate after the second stage, with no deaths. The mean KGR of the FLR after the preresection phase for PRALPPS was 3·8 (0·6–9·8) per cent/day, and that after PVE was 1·8 (0–6·7) per cent/day (P = 0·037). The mean time interval for FLR hypertrophy in the PRALPPS and PVE groups was 15 (6–29) and 20 (8–35) days respectively (P = 0·039).Conclusion Short‐term outcomes were similar for PRALPPS and PVE in terms of safety. Remnant hypertrophy was achieved more rapidly by PRALPPS.

Radiofrequency-assisted liver partition for staged hepatectomy (R-ALPPS). A preliminary experience with a fully laparoscopic first stage approach

Radiofrequency-assisted liver partition for staged hepatectomy (R-ALPPS). A preliminary experience with a fully laparoscopic first stage approach

Radiofrequency-assisted liver partition for staged hepatectomy (R-ALPPS). A preliminary experience with a fully laparoscopic first stage approach

Background: ALLPS is still a matter of debate among HPB surgeons. The main criticism concerns its worrisome complication rate. To reduce morbidity, few technical variations have been described. We present 2 cases of modified ALLPS, being the liver parenchyma laparoscopically ablated with radiofrequency (R-ALLPS). Methods: Recently, we carried out 2 R-ALLPS. Stage I was performed laparoscopically, right portal vein was secured by locking clips and liver partition was obtained by radiofrequency. Stage II required open right trisectionectomy (ORT). Results: Case 1: 67 year-old male with a metachronous colorectal liver metastasis involving S-IV/V/VII/VIII and middle hepatic vein. FLR/ETLV and FLR/BW were 15% and 0.33. CT volumetry was performed on day 8 and 15 after stage I. FLR/ETLV increased to 24%, FLR/BW to 0.52. An ORT was carried out. The patient developed transient grade A liver failure. Case 2: 70 year-old HBV-cirrhotic male with a huge HCC involving S-IV/VIII/VII with a right anterior portal pedicle thrombosis. FLR/ETLV and FLR/BW were 27% and 0.44. CT volumetry after 10 days showed FLR/ETLV and FLR/BW of 39% and 0.63. He was discharged 9 days after ORT without complications. Both patients were discharged 3 days after stage I R-ALLPS without complications. Conclusion: We believe that R-ALLPS will play a major role in patients in need of a two-staged hepatectomy due to its safety and feasibility. Trials are needed to compare the difference with ALLPS in inducing FLR hypertrophy both in normal and cirrhotic livers.

Comparison of CT and hepatobiliary scintigraphy in volumetry of future liver remnant after portal vein embolization and RALPPS

Background: The study was aimed to compare accuracy of CT and hepatobiliary scintigraphy (HBS) in volumetric estimation of future liver remnant (FLR) before and after portal vein embolization (PVE) and Radiofrequency Assisted Liver Partition with Portal vein embolization in Staged liver resection (RALPPS). Methods: During three years (January, 2015-December, 2017) 46 patients with different malignancies of liver and bile ducts included in the study: PVE (29) and RALLPS (17) were performed when major liver resection was indicated in patients with small FLR. Results: After PVE alone the mean rate of FLR hypertrophy estimated by HBS was significantly larger than the mean rate estimated by CT-volumetry: 71(20-171)% and 31(10-97)%, respectively (p=0,001). After RALPPS the mean rate of FLR hypertrophy estimated by HBS was also significantly larger than the mean rate estimated by CT-volumetry: 86(25-264)% and 45 (0-113)%, respectively (p=0,027). There was no significant differences in the rate of FLR hypertrophy between PVE and RALPPS, estimated by CT (p=0,099) and HBS (p=0,471). Conclusion: HBS is more effective and more precise method of FLR volumetry in comparison with CT-volumetry as HBS considers volumetry of functioning liver parenchyma. In terms of FLR hypertrophy RALPPS did not show evident advantage over PVE, nevertheless, there was a tendency to more effectiveness of RALPPS.

A totally laparoscopic associating liver partition and portal vein ligation for staged hepatectomy assisted with radiofrequency (radiofrequency assisted liver partition with portal vein ligation) for staged liver resection.

In order to induce liver hypertrophy to enable liver resection in patients with a small future liver remnant (FLR), various methods have been proposed in addition to portal vein embolisation (PVE). Most recently, the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique has gained significant international interest. This technique is limited by the high morbidity associated with an in situ liver splitting and the patient undergoing two open operations. We present the case of a variant ALPPS technique performed entirely laparoscopically with no major morbidity or mortality. An increased liver volume of 57.9% was seen after 14 days. This technique is feasible to perform and compares favourably to other ALPPS methods whilst gaining the advantages of laparoscopic surgery.

Bi-institutional case-matched comparison of short-term clinical outcomes of radiofrequency-assisted liver partition and portal vein ligation (RALPP) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)

Bi-institutional case-matched comparison of short-term clinical outcomes of radiofrequency-assisted liver partition and portal vein ligation (RALPP) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)

Variations and adaptations of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS): Many routes to the summit

Our aim was to review variations from the originally described associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure and relevant clinical outcomes. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (ie, PRISMA) guidelines. A search of PubMed and Google Scholar was conducted until March 2015. Inclusion criteria were any publications reporting technical variations and descriptions of ALPPS. Exclusion criteria were insufficient technical description, data repeated elsewhere, or data that could not be accessed in English. Initial search results returned 790 results; 46 studies were included in the final qualitative analysis. There were several alternatives described to the first stage of complete parenchymal split. Variations included partial ALPPS (partial split; hypertrophy of future liver remnant [FLR] 80-90%), radiofrequency-assisted liver partition and portal vein ligation (mean FLR hypertrophy 62%), laparoscopic microwave ablation and portal vein ligation (FLR hypertrophy 78-90%), associating liver tourniquet and portal ligation for staged hepatectomy (median FLR hypertrophy 61%), and sequential associating liver tourniquet and portal ligation for staged hepatectomy (FLR hypertrophy 77%) with a potential decrease in morbidity particularly after stage I. We analyzed several other variations, including considerations for segment IV, operative maneuvers, use of laparoscopy, identification of biliary complications, and liver containment. The current literature demonstrates a large variability in techniques of ALPPS that limits meaningful statistical comparisons of outcomes. Not physically splitting the liver at the first stage may decrease morbidity; however, randomized controlled trials are needed to determine benefits in technical variations.