Article
Impact of neoadjuvant chemotherapy on hypertrophy of the future liver remnant in ALPPS
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Published: | April 24, 2015 |
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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.