gms | German Medical Science

128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

In Situ-Split with Portal-Vein Ligation Induces Rapid Left Lateral Lobe Hypertrophy Enabling Two-Staged Extended Right Hepatic Resection in Patients with Marginal Resectability

Meeting Abstract

  • Andreas Schnitzbauer - Universitätsklinik Regensburg, Klinik und Poliklinik für Chirurgie, Regensburg
  • Sven Lang - Universitätsklinik Regensburg, Klinik und Poliklinik für Chirurgie, Regensburg
  • Pompiliu Piso - Krankenhaus Barmherzige Brüder, Klinik für Allgemein- und Viszeralchirurgie, Regensburg
  • Hauke Lang - Johannes-Gutenberg University Mainz , Department of General and Abdominal Surgery, Mainz
  • Hans Jürgen Schlitt - Universitätsklinikum Regensburg, Klinik und Poliklinik für Chirurgie, Regensburg

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch626

doi: 10.3205/11dgch626, urn:nbn:de:0183-11dgch6267

Published: May 20, 2011

© 2011 Schnitzbauer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: To evaluate a new surgical two-step technique for obtaining adequate but short-term parenchymal hypertrophy in oncologic patients requiring extended right hepatic resection with marginal resectability.

Materials and methods: Patients presenting with primary or metastatic liver tumors and limited alternative therapeutic options often face the dilemma that the remaining liver tissue is not sufficient. Portal vein embolization has so far been established as the standard for achieving resectability with increase in the left lateral lobe. We performed a two-staged hepatectomy in 12 patients that preoperatively appeared to be marginally resectable. In the first step, right portal vein ligation (PVL) and in situ split of the liver parenchyma along the falciform ligament was performed to prevent collateral perfusion. After a waiting time to allow hypertrophy a CT-volumetry was performed and the resection was completed.

Results: Six patients had the diagnosis of primary liver cancer (HCC: 2, ICC: 2, ECC: 1, Epitheloid hemangioendothelioma: 1), 5 patients had colorectal liver metastases (CRLM) and 1 patient had liver metastasis from cervix cancer. Patients had a preoperative CT-volumetry for the left lateral lobe of 359ml in median (min 197ml to max 475ml). After the first surgical step and a median waiting period of 10 days (min 9d to max 28d) the median volume of the left lateral lobe was 523ml (min 273ml to max 723ml) representing an increase in liver volume by 53% (min. 21% to 126%). Prompt perioperative recovery was reflected by laboratory parameters (Table 1 [Tab. 1]). The overall complication rate was high (24 events), mortality is 25% after a median follow up of 355 days (60 to 388 days).

Conclusion: Two-step hepatic resection performing PVL and in in situ split results in a rapid and enormous hypertrophy of functional liver tissue and enables curative resection of marginally resectable tumors and metastasis in patients otherwise being regarded palliative.