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Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery

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Portal Vein Embolization and ALPPS for Prevention of Post-Hepatectomy Liver Failure

https://doi.org/10.16931/1995-5464.2016356-63

Abstract

Aim. To estimate early and remote outcomes of portal vein embolization and ALPPS for prevention of post-hepatectomy
liver failure.
Material and Methods. 358 liver resections were performed for the period 2008–2016. There were 132 (36.9%) advanced
resections (over 4 segments). Cholangiocelullar carcinoma was diagnosed in 48 cases (36.4%), hepatocellular carcinoma – in 23 (17.4%) cases, colorectal liver metastases – in 19 (14.4%), parasitic liver diseases (hydatid disease, alveococcosis) – in 31 (23.5%) cases and others – in 11 (8.3%) cases. Vascular resection was performed in 42 (31.8%) patients, common bile and (or) common hepatic duct resection – in 76 (57.6%) cases. In this article 41 cases of portal
vein embolization with staged liver resection and 6 cases of ALPPS are described. Control group included 85 advanced liver resections without portal vein embolization.

Results. Portal vein embolization was effective in 41 (66%) cases: FLR growth was 52% (33;61) within average terms of 5.0 (4.0; 6.5) weeks. In ALPPS FLR growth was 70% (60; 77) after 11 (7; 17) days, in 1 case it was uneffective (FLR% – 30% after 24 days). The grade B+C of post hepatectomy liver failure was observed in 66 (50%) cases, infectious complications – in 39 (29.5%) cases, biliary complications – in 29 (21.9%) cases, post hepatectomy bleeding (grade C, ISGLS) – in 5 (3,8%) cases. In-hospital mortality was 8,3 %. Portal vein embolization decreased grade C post hepatectomy
liver failure (7.3% vs 20%) (p = 0.07).
Conclusion. Two-stage liver resection with primary embolization or ligation of the portal vein can reduce the frequency of post-resection liver failure. For certain patients ALPPS is the only method that allows to perform radical surgery and preserve necessary amount of hepatic parenchyma. However long-term results are unpredictable

About the Authors

A. E. Shcherba
Republican Research and Practical Center for Organ and Tissue Transplantation, 9th City Clinical Hospital
Russian Federation
Cand. of Med. Sci., Associate Professor, Head of the Transplantology


D. Yu. Efimov
Republican Research and Practical Center for Organ and Tissue Transplantation, 9th City Clinical Hospital
Russian Federation
Surgeon


L. V. Kirkovsky
Republican Research and Practical Center for Organ and Tissue Transplantation, 9th City Clinical Hospital
Russian Federation
Cand. of Med. Sci., Surgeon


D. I. Yurlevich
Republican Research and Practical Center for Organ and Tissue Transplantation, 9th City Clinical Hospital
Russian Federation
Head of the Endovascular Surgery


O. O. Rummo
Republican Research and Practical Center for Organ and Tissue Transplantation, 9th City Clinical Hospital
Russian Federation

Doct. of Med. Sci., Professor, Head



References

1. Щерба А.Е., Кирковский Л.В., Дзядзько А.М., Авдей Е.Л., Минов А.Ф., Болонкин Л.С., Руммо О.О. Резекция печени в условиях гипотермической консервации. Новости хирургии. 2012; 20 (6): 45–52. Shcherba A.E., Kirkovsky L.V., Dzyadzko A.M., Avdey E.L., Minov A.F., Bolonkin L.S., Rummo O.O. Liver resection under hypothermic perfusion. Novosti khirurgii. 2012; 20 (6): 45–52. (In Russian)


Review

For citations:


Shcherba A.E., Efimov D.Yu., Kirkovsky L.V., Yurlevich D.I., Rummo O.O. Portal Vein Embolization and ALPPS for Prevention of Post-Hepatectomy Liver Failure. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2016;21(3):56-63. (In Russ.) https://doi.org/10.16931/1995-5464.2016356-63

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ISSN 1995-5464 (Print)
ISSN 2408-9524 (Online)