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How should liver hypertrophy be stimulated? A comparison of upfront associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and portal vein embolization (PVE) with rescue possibility

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@article{ff534062d6444646bc2e79a1ec7b628c,
title = "How should liver hypertrophy be stimulated?: A comparison of upfront associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and portal vein embolization (PVE) with rescue possibility",
abstract = "Background: The role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in comparison to portal vein embolization (PVE) is debated. The aim of this study was to compare successful resection rates (RR) with upfront ALPPS vs. PVE with rescue ALPPS on demand and to compare the hypertrophy of the liver between ALPPS and PVE plus subsequent rescue ALPPS.Methods: A retrospective analysis of all patients treated with PVE for colorectal liver metastasis (CRLM) or ALPPS (any diagnosis, rescue ALPPS included) at five Scandinavian university hospitals during the years 2013-2016 was conducted. A Chi-square test and a Mann-Whitney U test were used to assess the difference between the groups. A successful RR was defined as liver resection without a 90-day mortality.Results: A total of 189 patients were included. Successful RR was in 84.5% of the patients with ALPPS upfront and in 73.3% of the patients with PVE and rescue ALPPS on demand (P=0.080). The hypertrophy of the future liver remnants (FLRs) with ALPPS upfront was 71% (48-97%) compared to 96% (82-113%) after PVE and rescue ALPPS (P=0.010).Conclusions: Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on demand. The sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.",
author = "Ernesto Sparrelid and Kristina Hasselgren and R{\o}sok, {B{\aa}rd Ingvald} and Larsen, {Peter N{\o}rgaard} and Schultz, {Nicolai Aagaard} and Ulrik Carling and Eva Fallentin and Stefan Gilg and Per Sandstr{\"o}m and Gert Lindell and Bergthor Bj{\"o}rnsson",
note = "2021 Hepatobiliary Surgery and Nutrition. All rights reserved.",
year = "2021",
month = jan,
doi = "10.21037/hbsn.2019.10.36",
language = "English",
volume = "10",
pages = "1--8",
journal = "HepatoBiliary Surgery and Nutrition",
issn = "2304-3881",
number = "1",

}

RIS

TY - JOUR

T1 - How should liver hypertrophy be stimulated?

T2 - A comparison of upfront associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and portal vein embolization (PVE) with rescue possibility

AU - Sparrelid, Ernesto

AU - Hasselgren, Kristina

AU - Røsok, Bård Ingvald

AU - Larsen, Peter Nørgaard

AU - Schultz, Nicolai Aagaard

AU - Carling, Ulrik

AU - Fallentin, Eva

AU - Gilg, Stefan

AU - Sandström, Per

AU - Lindell, Gert

AU - Björnsson, Bergthor

N1 - 2021 Hepatobiliary Surgery and Nutrition. All rights reserved.

PY - 2021/1

Y1 - 2021/1

N2 - Background: The role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in comparison to portal vein embolization (PVE) is debated. The aim of this study was to compare successful resection rates (RR) with upfront ALPPS vs. PVE with rescue ALPPS on demand and to compare the hypertrophy of the liver between ALPPS and PVE plus subsequent rescue ALPPS.Methods: A retrospective analysis of all patients treated with PVE for colorectal liver metastasis (CRLM) or ALPPS (any diagnosis, rescue ALPPS included) at five Scandinavian university hospitals during the years 2013-2016 was conducted. A Chi-square test and a Mann-Whitney U test were used to assess the difference between the groups. A successful RR was defined as liver resection without a 90-day mortality.Results: A total of 189 patients were included. Successful RR was in 84.5% of the patients with ALPPS upfront and in 73.3% of the patients with PVE and rescue ALPPS on demand (P=0.080). The hypertrophy of the future liver remnants (FLRs) with ALPPS upfront was 71% (48-97%) compared to 96% (82-113%) after PVE and rescue ALPPS (P=0.010).Conclusions: Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on demand. The sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.

AB - Background: The role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in comparison to portal vein embolization (PVE) is debated. The aim of this study was to compare successful resection rates (RR) with upfront ALPPS vs. PVE with rescue ALPPS on demand and to compare the hypertrophy of the liver between ALPPS and PVE plus subsequent rescue ALPPS.Methods: A retrospective analysis of all patients treated with PVE for colorectal liver metastasis (CRLM) or ALPPS (any diagnosis, rescue ALPPS included) at five Scandinavian university hospitals during the years 2013-2016 was conducted. A Chi-square test and a Mann-Whitney U test were used to assess the difference between the groups. A successful RR was defined as liver resection without a 90-day mortality.Results: A total of 189 patients were included. Successful RR was in 84.5% of the patients with ALPPS upfront and in 73.3% of the patients with PVE and rescue ALPPS on demand (P=0.080). The hypertrophy of the future liver remnants (FLRs) with ALPPS upfront was 71% (48-97%) compared to 96% (82-113%) after PVE and rescue ALPPS (P=0.010).Conclusions: Upfront ALPPS offers a somewhat higher successful RR than PVE with rescue ALPPS on demand. The sequential combination of PVE and ALPPS leads to a higher overall degree of hypertrophy than upfront ALPPS.

U2 - 10.21037/hbsn.2019.10.36

DO - 10.21037/hbsn.2019.10.36

M3 - Journal article

C2 - 33575285

VL - 10

SP - 1

EP - 8

JO - HepatoBiliary Surgery and Nutrition

JF - HepatoBiliary Surgery and Nutrition

SN - 2304-3881

IS - 1

ER -

ID: 62313979