Alexandre Chebaro1, Emmanuel Buc, Thibault Durin, Laurence Chiche, Raffaele Brustia, Alexandre Didier, François-René Pruvot, Yuki Kitano, Fabrice Muscari, Katia Lecolle, Laurent Sulpice, Ercin Sonmez, Marie Bougard, Mehdi El Amrani, Daniele Sommacale, Charlotte Maulat, Ahmet Ayav, René Adam, Christophe Laurent, Stéphanie Truant. 1. Department of Digestive Surgery and Transplantation, CHU Lille, University Lille, F-59000 Lille, France Department of Digestive Pathology, Surgery Unit, CHU Clermont Ferrand Hôtel Dieu NHE, Clermont Ferrand, France Department of Hepatobiliary Surgery, Haut Lévêque Hospital, CHU Bordeaux, France Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France Department of HPB Surgery, Nancy University Hospital, Nancy, France AP-HP Hôpital Paul Brousse, Centre Hépatobiliaire, Université Paris Saclay, Villejuif, France Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan Digestive Surgery Unit, University Hospital Rangueil, Toulouse, France Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France CANTHER laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies" UMR-S1277, Team "Mucins, Cancer and Drug Resistance", F-59000 Lille, France.
Abstract
OBJECTIVE: To compare two techniques of remnant liver hypertrophy in candidates for extended hepatectomy: radiological simultaneous portal vein (PVE) and hepatic vein embolization (HVE); namely liver venous deprivation (LVD), and ALPPS. SUMMARY BACKGROUND DATA: Recent advances in chemotherapy and surgical techniques have widened indications for extended hepatectomy, before which remnant liver augmentation is mandatory. ALPPS and LVD typically show higher hypertrophy rates than PVE, but their respective places in patient management remain unclear. METHODS: All consecutive ALPPS and LVD procedures performed in eight French centers between 2011 and 2020 were included. The main endpoint was the successful resection rate (resection rate without 90-day mortality) analyzed according to an intention-to-treat principle. Secondary endpoints were hypertrophy rates, intra- and post-operative outcomes. RESULTS: Among 209 patients, 124 had LVD 37 [13,1015] days before surgery, while 85 underwent ALPPS with an inter-stages period of 10 [6, 69] days. ALPPS was mostly-performed for colorectal liver metastases (CRLM), LVD for CRLM and perihilar cholangiocarcinoma. Hypertrophy was faster for ALPPS. Successful resection rates were 72.6% for LVD ± rescue ALPPS (n=6) versus 90.6% for ALPPS (p<0.001). Operative duration, blood losses and length-of-stay were lower for LVD, while 90-day major complications and mortality were comparable. Results were globally unchanged for CRLM patients, or after excluding the early 2 years of experience (learning-curve effect). CONCLUSIONS: This study is the first one comparing LVD versus ALPPS in the largest cohort so far. Despite its retrospective design, it yields original results that may serve as the basis for a prospective study.
OBJECTIVE: To compare two techniques of remnant liver hypertrophy in candidates for extended hepatectomy: radiological simultaneous portal vein (PVE) and hepatic vein embolization (HVE); namely liver venous deprivation (LVD), and ALPPS. SUMMARY BACKGROUND DATA: Recent advances in chemotherapy and surgical techniques have widened indications for extended hepatectomy, before which remnant liver augmentation is mandatory. ALPPS and LVD typically show higher hypertrophy rates than PVE, but their respective places in patient management remain unclear. METHODS: All consecutive ALPPS and LVD procedures performed in eight French centers between 2011 and 2020 were included. The main endpoint was the successful resection rate (resection rate without 90-day mortality) analyzed according to an intention-to-treat principle. Secondary endpoints were hypertrophy rates, intra- and post-operative outcomes. RESULTS: Among 209 patients, 124 had LVD 37 [13,1015] days before surgery, while 85 underwent ALPPS with an inter-stages period of 10 [6, 69] days. ALPPS was mostly-performed for colorectal liver metastases (CRLM), LVD for CRLM and perihilar cholangiocarcinoma. Hypertrophy was faster for ALPPS. Successful resection rates were 72.6% for LVD ± rescue ALPPS (n=6) versus 90.6% for ALPPS (p<0.001). Operative duration, blood losses and length-of-stay were lower for LVD, while 90-day major complications and mortality were comparable. Results were globally unchanged for CRLM patients, or after excluding the early 2 years of experience (learning-curve effect). CONCLUSIONS: This study is the first one comparing LVD versus ALPPS in the largest cohort so far. Despite its retrospective design, it yields original results that may serve as the basis for a prospective study.