In:
ANZ Journal of Surgery, Wiley, Vol. 88, No. 4 ( 2018-04)
Abstract:
Recently a procedure termed ‘Associating Liver Partition and Portal vein ligation for Staged hepatectomy’ ( ALPPS ) was developed to increase the resectability of marginally resectable or locally unresectable liver tumours. This study focused on the application of ALPPS in patients with advanced colorectal liver metastases ( CRLM ) and pre‐operative chemotherapy, with the aim to investigate whether the latter still allows for sufficient hypertrophy of the future liver remnant (FLR) following the first step of ALPPS . Methods Retrospective analysis was performed on six patients suffering from advanced CRLM . Analyses comprised demographical and basic clinical data, the perioperative courses as well as short‐ and long‐term outcomes. Results All patients presented with bilobular CRLM and pre‐operative chemotherapy of at least 6 months. Extended right hemihepatectomy was performed in all cases, four patients additionally received atypical resections in segments II / III . Mean FLR prior to step 1 of ALPPS was 397.9 cm 3 (121–753 cm 3 ), on average representing 20.9% of the total liver volume (13.2–27.1%). A mean hypertrophy of the FLR of 67.9% (32.5–94.1%) was achieved. Overall, severe morbidity (Dindo Clavien 〉 3a) occurred in two patients. Following completion of ALPPS , mean post‐operative disease‐free survival was 5.7 months (2.6–8.9 months). Conclusion Despite pre‐operative chemotherapy, ALPPS seems to result in adequate liver hypertrophy, preventing post‐operative small‐for‐size syndrome. However, there might be a high risk of tumour recurrence in patients with an aggressive tumour biology.
Type of Medium:
Online Resource
ISSN:
1445-1433
,
1445-2197
DOI:
10.1111/ans.2018.88.issue-4
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
2095927-8
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