Comparative study of right portal vein ligation versus embolisation for induction of hypertrophy in two-stage hepatectomy for multiple bilateral colorectal liver metastases

Staged resection of bilobar colorectal liver metastases: surgical strategies

“…PVL was shown to be able to induce hypertrophy of the future liver remnant. In comparison, PVE is the more effective technique to increase the future liver remnant, possibly due to lack of portal occlusion in distal branches of the portal vein [42][43][44]. In line with this theory, Wilms et al emphasized collaterals between occluded and non-occluded liver segments as the underlying cause of inferior regeneration in the PVL group [44].…”

Asociación de Partición Hepática y Ligadura Portal para Hepatectomía por Etapas (ALPPS)

“…En 2011 se describió el "associating liver partition and portal ligation for staged hepatectomy" (ALPPS); alternativa innovadora, que permite lograr resultados similares a los anteriores, pero en tiempos menores (Baumgart et al, 2011); y a partir de 2012, comenzaron a publicarse las primeras series de ALPPS (Schnitzbauer et al, 2012;Torres et al, 2013;De Santibañes & Clavien, 2012;Robles et al, 2012) (Figs. 1-3).…”

Laparoscopic First Stage in a Two-Stage Hepatectomy

“…1,4 Later, in 2012, Robles et al published another 2 totally laparoscopic TS procedures. 8 The longest reported experience is that of a series of 8 partially/totally laparoscopic TS strategies, 5 with an initial laparoscopic stage and a second laparotomy stage, one conversion to laparotomy, and only 2 completely laparoscopic cases. 6 The first stage of TS can usually be completed laparoscopically as it generally entails minor hepatectomy of the left liver, which may or may not be associated with colon surgery and/or right portal vein ligation.…”

“…[1][2][3][4] The major problem is that only 20%-25% of HM are initially resectable, which is usually due to insufficient future remnant liver volume. [4][5][6][7][8] In patients with initially unresectable HM, there are several strategies used to increase resectability: in situ split, neoadjuvant chemotherapy, combined surgery and radiofrequency ablation, and two-stage (TS) surgery combined with portal embolization, developed by Adam et al 1,[4][5][6][7][8] In the first stage of TS surgery, the metastases located in the future remnant (usually the left liver) are resected. 1,[5][6][7][8][9] After portal vein ligation or embolization, the second stage of surgery involves major hepatectomy of the embolized lobe.…”