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Article: Impact of split completeness on future liver remnant hypertrophy in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma: Complete-ALPPS versus partial-ALPPS
Title | Impact of split completeness on future liver remnant hypertrophy in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma: Complete-ALPPS versus partial-ALPPS |
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Authors | |
Issue Date | 2017 |
Publisher | Mosby, Inc. The Journal's web site is located at http://www.medicinepublishing.co.uk/index.php/surgery/ |
Citation | Surgery, 2017, v. 161 n. 2, p. 357-364 How to Cite? |
Abstract | Background:
Recent evidence suggested that associating liver partition and portal vein ligation for staged hepatectomy with a partial split could effectively induce the same degree of future liver remnant hypertrophy as a complete split in non-cirrhotic and non-cholestatic livers with better postoperative safety profiles. Our aim was to evaluate if the same phenomenon could be applied to hepatitis-related chronic liver diseases.
Methods:
In the study, 25 patients who underwent associating liver partition and portal vein ligation for staged hepatectomy from October 2013 to January 2016 for hepatocellular carcinoma were analyzed. Partial-associating liver partition and portal vein ligation for staged hepatectomy (n = 12) was defined as 50–80% of the transection surface split and complete-associating liver partition and portal vein ligation for staged hepatectomy (n = 13) was split down to inferior vena cava. Perioperative outcomes stratified by split completeness were evaluated.
Results:
There was no significant difference in operating times and blood loss for stage I and II operations between complete-associating liver partition and portal vein ligation for staged hepatectomy and partial-associating liver partition and portal vein ligation for staged hepatectomy. All patients underwent stage II operation without any inter-stage complications. Complete split induced greater future liver remnant hypertrophy than partial split (hypertrophy rate: 31.2 vs 17.5 mL/day, P = .022) with more pronounced effect in chronic hepatitis (P = .007) than cirrhosis (P = .283). Complete-associating liver partition and portal vein ligation for staged hepatectomy was more likely to attain a future liver remnant/estimated standard liver volume ratio >35% within 10 days (76.9% vs 33.3%, P = .024) and proceed to stage II within 14 days after stage I (100% vs 58.4%, P = .009). The overall postoperative morbidity (≥grade 3a) after stage II was 16% (complete versus partial split: 7.7% vs 25%, P = .238) and hospital mortality after stage II was 8% (complete versus partial split: 0% vs 16.7%, P = .125).
Conclusion:
Complete-associating liver partition and portal vein ligation for staged hepatectomy induced more rapid future liver remnant hypertrophy than partial-associating liver partition and portal vein ligation for staged hepatectomy without increased perioperative risk in chronic liver diseases. |
Persistent Identifier | http://hdl.handle.net/10722/237044 |
ISSN | 2023 Impact Factor: 3.2 2023 SCImago Journal Rankings: 1.096 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Chan, ACY | - |
dc.contributor.author | Chok, KSH | - |
dc.contributor.author | Dai, WC | - |
dc.contributor.author | Lo, CM | - |
dc.date.accessioned | 2016-12-20T06:15:27Z | - |
dc.date.available | 2016-12-20T06:15:27Z | - |
dc.date.issued | 2017 | - |
dc.identifier.citation | Surgery, 2017, v. 161 n. 2, p. 357-364 | - |
dc.identifier.issn | 0039-6060 | - |
dc.identifier.uri | http://hdl.handle.net/10722/237044 | - |
dc.description.abstract | Background: Recent evidence suggested that associating liver partition and portal vein ligation for staged hepatectomy with a partial split could effectively induce the same degree of future liver remnant hypertrophy as a complete split in non-cirrhotic and non-cholestatic livers with better postoperative safety profiles. Our aim was to evaluate if the same phenomenon could be applied to hepatitis-related chronic liver diseases. Methods: In the study, 25 patients who underwent associating liver partition and portal vein ligation for staged hepatectomy from October 2013 to January 2016 for hepatocellular carcinoma were analyzed. Partial-associating liver partition and portal vein ligation for staged hepatectomy (n = 12) was defined as 50–80% of the transection surface split and complete-associating liver partition and portal vein ligation for staged hepatectomy (n = 13) was split down to inferior vena cava. Perioperative outcomes stratified by split completeness were evaluated. Results: There was no significant difference in operating times and blood loss for stage I and II operations between complete-associating liver partition and portal vein ligation for staged hepatectomy and partial-associating liver partition and portal vein ligation for staged hepatectomy. All patients underwent stage II operation without any inter-stage complications. Complete split induced greater future liver remnant hypertrophy than partial split (hypertrophy rate: 31.2 vs 17.5 mL/day, P = .022) with more pronounced effect in chronic hepatitis (P = .007) than cirrhosis (P = .283). Complete-associating liver partition and portal vein ligation for staged hepatectomy was more likely to attain a future liver remnant/estimated standard liver volume ratio >35% within 10 days (76.9% vs 33.3%, P = .024) and proceed to stage II within 14 days after stage I (100% vs 58.4%, P = .009). The overall postoperative morbidity (≥grade 3a) after stage II was 16% (complete versus partial split: 7.7% vs 25%, P = .238) and hospital mortality after stage II was 8% (complete versus partial split: 0% vs 16.7%, P = .125). Conclusion: Complete-associating liver partition and portal vein ligation for staged hepatectomy induced more rapid future liver remnant hypertrophy than partial-associating liver partition and portal vein ligation for staged hepatectomy without increased perioperative risk in chronic liver diseases. | - |
dc.language | eng | - |
dc.publisher | Mosby, Inc. The Journal's web site is located at http://www.medicinepublishing.co.uk/index.php/surgery/ | - |
dc.relation.ispartof | Surgery | - |
dc.title | Impact of split completeness on future liver remnant hypertrophy in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in hepatocellular carcinoma: Complete-ALPPS versus partial-ALPPS | - |
dc.type | Article | - |
dc.identifier.email | Chan, ACY: acchan@hku.hk | - |
dc.identifier.email | Chok, KSH: chok6275@hku.hk | - |
dc.identifier.email | Dai, WC: daiwc@hku.hk | - |
dc.identifier.email | Lo, CM: chungmlo@hkucc.hku.hk | - |
dc.identifier.authority | Chan, ACY=rp00310 | - |
dc.identifier.authority | Chok, KSH=rp02110 | - |
dc.identifier.authority | Lo, CM=rp00412 | - |
dc.description.nature | link_to_OA_fulltext | - |
dc.identifier.doi | 10.1016/j.surg.2016.07.029 | - |
dc.identifier.scopus | eid_2-s2.0-84994486621 | - |
dc.identifier.hkuros | 270728 | - |
dc.identifier.volume | 161 | - |
dc.identifier.issue | 2 | - |
dc.identifier.spage | 357 | - |
dc.identifier.epage | 364 | - |
dc.identifier.isi | WOS:000392904400012 | - |
dc.publisher.place | United States | - |
dc.identifier.issnl | 0039-6060 | - |