gms | German Medical Science

132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

Impact of neoadjuvant chemotherapy on hypertrophy of the future liver remnant in ALPPS

Meeting Abstract

  • Michael Kremer - Universitätsklinikum Ulm, Abteilung für Allgemein- und Viszeralchirurgie, Ulm, Deutschland
  • Giulia Manzini - Chirurgische Universitätsklinik Heidelberg, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Branimir Hristov - Chirurgische Universitätsklinik Heidelberg, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Theresa Mokry - Radiologische Universitätsklinik Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg, Deutschland
  • Christoph M. Sommer - Radiologische Universitätsklinik Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg, Deutschland
  • Georgios Polychronidis - Chirurgische Universitätsklinik Heidelberg, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Arianeb Mehrabi - Chirurgische Universitätsklinik Heidelberg, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Jürgen Weitz - Chirurgische Universitätsklinik Heidelberg, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Markus W. Büchler - Chirurgische Universitätsklinik Heidelberg, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland
  • Peter Schemmer - Chirurgische Universitätsklinik Heidelberg, Abteilung für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch208

doi: 10.3205/15dgch208, urn:nbn:de:0183-15dgch2082

Published: April 24, 2015

© 2015 Kremer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Introduction: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been demonstrated as feasible procedure in extended liver resections as a means of successfully increasing the volume of the future liver remnant (FLR). Neoadjuvant chemotherapy (CTx) is toxic to the organ and may impair hepatic regeneration. Since most patients with colorectal liver metastasis undergo CTx, this study was performed to assess the procedure´s effect on hypertrophy of the FLR.

Material and methods: Nineteen consecutive ALPPS patients of which 53% (n=10) received neoadjuvant CTx were analyzed. Patients presented with multifocal, colorectal liver metastasis (58%), cholangiocarcinoma in Klatskin position (37%), and gallbladder carcinoma (5%). Hepatectomy was performed within 6-13 days after hepatic partition. Extended right hepatectomy was performed in 16 cases. Right hepatectomy was performed in three patients who had previously undergone substantial hepatic resection. Volumetry was performed prior to both liver partitioning and hepatectomy.

Results: Liver partition and portal vein ligation induced sufficient hypertrophy of the FLR with an increased volume of 74±35%. In general, patients underwent hepatectomy after a median of eight days and in all cases, R0 resection was achieved. CTx was shown to significantly impair hypertrophy. The volume of the FLR in non-CTx patients increased by 98±35%, whereas an increase of 59±22% was observed in patients who underwent CTx (p=0.027). CTx did not have an impact on both morbidity and in hospital mortality which were 74% and 16%, respectively.

Conclusion: We show for the first time that neoadjuvant chemotherapy impairs significantly the hypertrophy of the future remnant liver after ALPPS without impact on the postoperative course. Despite this, morbidity and perioperative mortality warrant careful patient selection and responsible use of the ALPPS procedure.