Analysis of the efficacy of portal vein embolization for patients with extensive liver malignancy and very low future liver remnant volume, including a comparison with the associating liver partition with portal vein ligation for staged hepatectomy approach.
Analysis of the efficacy of portal vein embolization for patients with extensive liver malignancy and very low future liver remnant volume, including a comparison with the associating liver partition with portal vein ligation for staged hepatectomy approach.
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DOI：
10.1016/j.jamcollsurg.2013.03.004
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发表时间：
2013-07
影响因子：
5.2
通讯作者：
Aloia, Thomas A.
中科院分区：
文献类型：
--
作者：
Shindoh, Junichi;Vauthey, Jean-Nicolas;Zimmitti, Giuzeppe;Curley, Steven A.;Huang, Steven Y.;Mahvash, Armeen;Gupta, Sanjay;Wallace, Michael J.;Aloia, Thomas A.
联合肝脏分割和门静脉结扎进行分期肝切除术（ALPPS）技术的主要报告适应症是未来肝脏残留量非常低的患者。鉴于ALPPS的主要发病率（40%）和肝脏相关死亡率（12%）升高，我们试图确定经皮门静脉栓塞（PVE）在类似患者人群中的安全性和有效性。对144例未来肝残体/体重比（LR/BW）小于0.5%的连续肝肿瘤患者的肿瘤可切除性和发病率/死亡率进行了审查。所有患者均接受术前经皮右+IV节段PVE，使用栓塞微球，计划在PVE后30天重新评估LR/BW。将PVE后结局与ALPPS报告的结局进行比较。144例研究患者中有141例（97.9%）成功进行了经皮PVE。在139例患者（98.5%）中观察到充分再生，PVE后LR/BW中位数从0.33%上升至0.52%（p<0.0001），表示每例患者的中位数再生为62%（范围：0.3 - 379%）。共有104例患者接受了扩大右半肝切除术（n=102）或右半肝切除术（n=2）。其余40例患者（27.8%）由于短间隔疾病进展（27例患者，18.5%）、肝再生不足（5例患者，3.5%）和医学合并症（8例患者，5.6%）而不可切除。切除后，观察到以下结局：主要发病率：33.0%（34/104），肝功能不全：12.5%（13/104），90天肝脏相关死亡率：5.8%（6/104）。这些肿瘤学和技术结果优于ALPPS。基于其选择肿瘤可切除患者的能力以及上级安全性和有效性特征，经皮右+节段IV PVE和间隔手术仍然是未来肝脏残留量非常低的患者的标准治疗。
The primary reported indication for the Associating Liver Partition with Portal vein Ligation for Staged hepatectomy (ALPPS) technique is in patients with very low future liver remnant volumes. Given the elevated incidence of major morbidity (40%) and liver-related mortality (12%) with ALPPS, we sought to determine the safety and efficacy of percutaneous portal vein embolization (PVE) in a similar patient population. Tumor resectability and morbidity/mortality rates were reviewed for 144 consecutive liver tumor patients with future liver remnant to body weight ratios (LR/BW) less than 0.5%. All patients were referred for preoperative percutaneous right plus segment IV PVE using embolic microspheres, with planned reassessment of the LR/BW 30 days after PVE. Post-PVE outcomes were compared to reported outcomes for ALPPS. Percutaneous PVE was successfully performed in 141 of the 144 study patients (97.9%). Adequate regeneration was observed in 139 patients (98.5%) with median post-PVE LR/BW rising from 0.33% to 0.52% (p<0.0001), representing a per-patient median regeneration of 62% (range: 0.3 – 379%). In total, 104 patients underwent extended right hepatectomy (n=102) or right hepatectomy (n=2). The remaining 40 patients (27.8%) were not resectable due to short-interval disease progression (27 patients, 18.5%), insufficient liver regeneration (5 patients, 3.5%), and medical comorbidities (8 patients, 5.6%). After resection, the following outcomes were observed: major morbidity: 33.0% (34/104), liver insufficiency: 12.5% (13/104), and 90-day liver-related mortality: 5.8% (6/104). These oncologic and technical results compare favorably to those of ALPPS. Based on its ability to select oncologically resectable patients and superior safety and efficacy profiles, percutaneous right+segment IV PVE and interval surgery remains the standard of care for patients with very low future liver remnant volumes.
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影响因子：
3.8
作者：
Kishi, Yoji;Madoff, David C.;Vauthey, Jean-Nicolas
通讯作者：
Vauthey, Jean-Nicolas
影响因子：
9
作者：
Schnitzbauer, Andreas A.;Lang, Sven A.;Schlitt, Hans J.
通讯作者：
Schlitt, Hans J.
影响因子：
9.6
作者：
Knoefel, W. T.;Gabor, I.;Topp, S. A.
通讯作者：
Topp, S. A.
DOI：
10.1016/j.jamcollsurg.2006.12.032
发表时间：
2007-05-01
影响因子：
5.2
作者：
Mullen, John T.;Ribero, Dario;Vauthey, Jean-Nicolas
通讯作者：
Vauthey, Jean-Nicolas
影响因子：
--
作者：
Abdalla, EK;Barnett, CC;Vauthey, JN
通讯作者：
Vauthey, JN