Impact of Neoadjuvant Chemotherapy on Hypertrophy of the Future Liver Remnant after Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Michael Kremer - , Heidelberg University  (Author)
  • Giulia Manzini - , Heidelberg University  (Author)
  • Branimir Hristov - , Heidelberg University  (Author)
  • Georg Polychronidis - , Heidelberg University  (Author)
  • Theresa Mokry - , Heidelberg University  (Author)
  • Christoph M. Sommer - , Heidelberg University  (Author)
  • Arianeb Mehrabi - , Heidelberg University  (Author)
  • Jürgen Weitz - , Department of internal Medicine III - Division General Medicine, Department of Visceral, Thoracic and Vascular Surgery, Heidelberg University  (Author)
  • Markus W. Büchler - , Heidelberg University  (Author)
  • Peter Schemmer - , Heidelberg University  (Author)

Abstract

Background Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been demonstrated as a 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. This study was performed to assess the procedure's effect on hypertrophy of the FLR, including the short-term survival. Study design We analyzed 19 consecutive ALPPS patients, of whom 58% (n = 11) received neoadjuvant CTx because of colorectal liver metastasis (CRM). Patients presented with multifocal CRM (n = 11, 58%); cholangiocarcinoma (n = 7, 37%), of which 5 were in the Klatskin position; and gallbladder carcinoma (n = 1, 5%). Hepatectomy was performed within 6 to 13 days after hepatic partition. Volumetry was performed before both liver partitioning and hepatectomy. A survival analysis was performed. Results Liver partition and portal vein ligation induced sufficient hypertrophy of the FLR, with an increased volume of 74% ± 35%. Patients underwent hepatectomy after a median of 8 days; in all cases R0 resection was achieved. Neoadjuvant CTx was shown to significantly impair hypertrophy. The volume of the FLR in non-CTx patients increased by 98% ± 35%; an increase of 59% ± 22% was observed in patients who underwent CTx (p = 0.027). Chemotherapy did not have an impact on either morbidity or in-hospital mortality, which were 68% and 16%, respectively. One-year overall survival was 53%, with a 1-year survival of 67% in CRM patients and 38% in non-CRM patients (p > 0.05). Conclusions Data presented here demonstrate for the first time that neoadjuvant CTx significantly impairs hypertrophy of the FLR after ALPPS.

Details

Original languageEnglish
Article number7929
Pages (from-to)717-728.e1
JournalJournal of the American College of Surgeons
Volume221
Issue number3
Publication statusPublished - 1 Sept 2015
Peer-reviewedYes

External IDs

PubMed 26232303

Keywords

ASJC Scopus subject areas