Detailed Abstract
[E-poster - Liver (Liver Disease/Surgery)]
[EP 012] Optimization of future remnant liver before major hepatectomy-efficacy and safety of different procedures.
Nikolay BELEV1
1Department of Surgery, UMHAT-Eurohospital, Faculty of Medicine, Medical University-Plovdiv, Bulgaria
Background : Portal vein embolization (PVE) is generally considered the standard technique for inducing increase in FLR, but there is20% unsuitable rate for resection due to either insufficient FLR growth or tumor progression during the post-PVE period. To overcome these limitations, associating liver partition and portal vein ligation (ALPPS), has been recently introduced. These techniques showed greater and faster hypertrophy than PVE, but at the cost of significantly higher morbidity and mortality. In the past 5 years, has been proposed the simultaneous embolization of the portal vein and one or two hepatic veins, to increase the damage to the liver leading to an increase in hypertrophy of the contralateral parenchyma- liver venous deprivation (LVD).
Methods : For ten years period (2013-2023) 186 patients underwent liver surgery for CRLM. We performed 107 laparoscopic liver surgeries and 79 open procedures. The primary aim was estimate the efficacy of different procedures, including standardized FLR (sFLR) increase, time to hepatectomy, resection rate. The secondary point was the safety of different treatments, including the rate of Clavien-Dindo≥3a and 90-day mortality.
Results : One meta-analysis, three randomized controlled trials (RCTs), three prospective trials (PTs) and our experience were recruited in this study. ALPPS had much higher sFLR increase when compared to another techniques. ALPPS showed significantly shorter time to hepatectomy. ALPPS had comparable resection rate with LVD. ALPPS had a higher Clavien-Dindo≥3a complication rate and 90-day mortality compared to other treatments, although there were no significant differences between different procedures. We successful completed the second stage of procedure in twelve patients (57%). Complications rate was 25%. The ninety-dais mortality was 8,3(1 patients was died 76 days after surgery).
Conclusions : ALPPS demonstrated a higher regeneration rate, shorter time to hepatectomy, and higher resection rate, but ALPPS developed the trend of higher Clavien-Dindo≥3a complication rate.
Methods : For ten years period (2013-2023) 186 patients underwent liver surgery for CRLM. We performed 107 laparoscopic liver surgeries and 79 open procedures. The primary aim was estimate the efficacy of different procedures, including standardized FLR (sFLR) increase, time to hepatectomy, resection rate. The secondary point was the safety of different treatments, including the rate of Clavien-Dindo≥3a and 90-day mortality.
Results : One meta-analysis, three randomized controlled trials (RCTs), three prospective trials (PTs) and our experience were recruited in this study. ALPPS had much higher sFLR increase when compared to another techniques. ALPPS showed significantly shorter time to hepatectomy. ALPPS had comparable resection rate with LVD. ALPPS had a higher Clavien-Dindo≥3a complication rate and 90-day mortality compared to other treatments, although there were no significant differences between different procedures. We successful completed the second stage of procedure in twelve patients (57%). Complications rate was 25%. The ninety-dais mortality was 8,3(1 patients was died 76 days after surgery).
Conclusions : ALPPS demonstrated a higher regeneration rate, shorter time to hepatectomy, and higher resection rate, but ALPPS developed the trend of higher Clavien-Dindo≥3a complication rate.
SESSION
E-poster
E-Session 03/21 ALL DAY