Michael Linecker1, Patryk Kambakamba1, Cäcilia S Reiner2, Thi Dan Linh Nguyen-Kim2, Gregor A Stavrou3, Robert M Jenner4, Karl J Oldhafer3, Bergthor Björnsson5, Andrea Schlegel1, Georg Györi1, Marcel André Schneider1, Mickael Lesurtel6, Pierre-Alain Clavien1, Henrik Petrowsky7. 1. Swiss HPB and Transplantation Center, University Hospital Zurich, Zurich, Switzerland. 2. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland. 3. Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany; Semmelweis University Budapest, Campus Hamburg, Hamburg, Germany. 4. Department of General and Abdominal Surgery, Asklepios Hospital Barmbek, Hamburg, Germany. 5. Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. 6. Swiss HPB and Transplantation Center, University Hospital Zurich, Zurich, Switzerland; Department of General Surgery and Liver, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon, Lyon, France. 7. Swiss HPB and Transplantation Center, University Hospital Zurich, Zurich, Switzerland. Electronic address: Henrik.Petrowsky@usz.ch.
Abstract
BACKGROUND: ALPPS induces rapid liver hypertrophy after stage-1 operation, enabling safe, extended resections (stage-2) after a short period. Recent studies have suggested that partial transection at stage-1 might be associated with a better safety profile. The aim of this study was to assess the amount of liver parenchyma that needs to be divided to achieve sufficient liver hypertrophy in ALPPS. METHODS: In a bi-institutional, prospective cohort study, nonfibrotic patients who underwent ALPPS with complete (n = 22) or partial (n = 23) transection for colorectal liver metastases were analyzed and compared with an external ALPPS cohort (n = 23). A radiologic tool was developed to quantify the amount of parenchymal transection. Liver hypertrophy and clinical outcome were compared between both techniques. The relationship of partial transection and hypertrophy was investigated further in an experimental murine model of partial ALPPS. RESULT: The median amount of parenchymal transection in partial ALPPS was 61% (range, 34-86%). The radiologic method correlated poorly with the intraoperative surgeon's estimation (rS = 0.258). Liver hypertrophy was equivalent for the partial ALPPS, ALPPS, and external ALPPS cohort (64% vs 60% vs. 64%). Experimental data demonstrated that partial transection of at least 50% induced comparable hypertrophy (137% vs 156%) and hepatocyte proliferation compared to complete transection. CONCLUSION: The study provides clinical and experimental evidence that partial liver partition of at least 50% seems to be equally effective in triggering volume hypertrophy as observed with complete transection and can be re recommended as less invasive alternative to ALPPS.
BACKGROUND: ALPPS induces rapid liver hypertrophy after stage-1 operation, enabling safe, extended resections (stage-2) after a short period. Recent studies have suggested that partial transection at stage-1 might be associated with a better safety profile. The aim of this study was to assess the amount of liver parenchyma that needs to be divided to achieve sufficient liver hypertrophy in ALPPS. METHODS: In a bi-institutional, prospective cohort study, nonfibrotic patients who underwent ALPPS with complete (n = 22) or partial (n = 23) transection for colorectal liver metastases were analyzed and compared with an external ALPPS cohort (n = 23). A radiologic tool was developed to quantify the amount of parenchymal transection. Liver hypertrophy and clinical outcome were compared between both techniques. The relationship of partial transection and hypertrophy was investigated further in an experimental murine model of partial ALPPS. RESULT: The median amount of parenchymal transection in partial ALPPS was 61% (range, 34-86%). The radiologic method correlated poorly with the intraoperative surgeon's estimation (rS = 0.258). Liver hypertrophy was equivalent for the partial ALPPS, ALPPS, and external ALPPS cohort (64% vs 60% vs. 64%). Experimental data demonstrated that partial transection of at least 50% induced comparable hypertrophy (137% vs 156%) and hepatocyte proliferation compared to complete transection. CONCLUSION: The study provides clinical and experimental evidence that partial liver partition of at least 50% seems to be equally effective in triggering volume hypertrophy as observed with complete transection and can be re recommended as less invasive alternative to ALPPS.
Authors: Henrik Petrowsky; Ralph Fritsch; Matthias Guckenberger; Michelle L De Oliveira; Philipp Dutkowski; Pierre-Alain Clavien Journal: Nat Rev Gastroenterol Hepatol Date: 2020-07-17 Impact factor: 46.802
Authors: Ivan Capobianco; Karl J Oldhafer; Mohammed-Hossein Fard-Aghaie; Ricardo Robles-Campos; Roberto Brusadin; Henrik Petrowsky; Michael Linecker; Arianeb Mehrabi; Katrin Hoffmann; Jun Li; Asmus Heumann; Roberto Hernandez-Alejandro; Mauro Enrique Tun-Abraham; Elio Jovine; Matteo Serenari; Bergthor Bjornsson; Per Sandström; Ruslan Alikhanov; Mikhail Efanov; Paolo Muiesan; Andrea Schlegel; Thomas M van Gulik; Pim B Olthof; Gregor Alexander Stavrou; Lina Maria Serna-Higuita; Alfred Königsrainer; Silvio Nadalin Journal: Hepatobiliary Surg Nutr Date: 2022-02 Impact factor: 7.293
Authors: Gregor A Stavrou; Marcello Donati; Mohammad H Fard-Aghaie; Martin Zeile; Tessa M Huber; Axel Stang; Karl J Oldhafer Journal: Visc Med Date: 2017-11-30
Authors: Per Sandström; Bård I Røsok; Ernesto Sparrelid; Peter N Larsen; Anna L Larsson; Gert Lindell; Nicolai A Schultz; Bjorn A Bjørnbeth; Bengt Isaksson; Magnus Rizell; Bergthor Björnsson Journal: Ann Surg Date: 2018-05 Impact factor: 12.969