In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection

BMC Surgery

Yan Klosterkemper¹  Lars Schimmöller¹  Alexander Rehders²  Nadja Lehwald-Tywuschik²  Hany Ashmawy²  Sascha Vaghiri²  Salman Alaghmand²  Andreas Krieg²  Wolfram Trudo Knoefel²  Jan Schulte am Esch³  Stefan A. Topp⁴  Anja Lachenmayer⁵ 

[1] Department of Diagnostic and Interventional Radiology, University Hospital Duesseldorf;Department of Surgery A, University Hospital Duesseldorf;Present address: Center of Visceral Medicine, Department of Visceral Surgery, Protestant Hospital of Bethel Foundation;Present address: Department of Surgery, Ameos Hospital;Present ccaddress: Department of Visceral Surgery and Medicine, University Hospital Bern, University of Bern;

关键词: ALPPS;    Liver resection;    In situ split;    Future liver remnant;    Liver hypertrophy;   

DOI  :  10.1186/s12893-020-00721-y

来源: DOAJ

【 摘 要 】

Abstract Background Right extended liver resection is frequently required to achieve tumor-free margins. Portal venous embolization (PVE) of the prospective resected hepatic segments for conditioning segments II/III does not always induce adequate hypertrophy in segments II and III (future liver remnant volume (FLRV)) for extended right-resection. Here, we present the technique of in situ split dissection along segments II/III plus portal disruption to segments IV-VIII (ISLT) as a salvage procedure to overcome inadequate gain of FLRV after PVE. Methods In eight patients, FLRV was further pre-conditioned following failed PVE prior to hepatectomy (ISLT-group). We compared FLRV changes in the ISLT group with patients receiving extended right hepatectomy following sufficient PVE (PVEres-group). Survival of the ISLT-group was compared to PVEres patients and PVE patients with insufficient FLRV gain or tumor progress who did not receive further surgery (PVEnores-group). Results Patient characteristics and surgical outcome were comparable in both groups. The mean FLRV-to-body-weight ratio in the ISLT group was smaller than in the PVEres-group pre- and post-PVE. One intraoperative mortality due to a coronary infarction was observed for an ISLT patient. ISLT was successfully completed in the remaining seven ISLT patients. Liver function and 2-year survival of ~ 50% was comparable to patients with extended right hepatectomy after efficient PVE. Patients who received a PVE but who were not subsequently resected (PVEnores) demonstrated no survival beyond 4 months. Conclusion Despite extended embolization of segments I and IV-VIII, ISLT should be considered if hypertrophy was not adequate. Liver function and overall survival after ISLT was comparable to patients with trisectionectomy after efficient PVE.

【 授权许可】

Unknown