Ligation of the middle hepatic vein to increase hypertrophy induction during the ALPPS procedure

Abstract

Purpose Here, we analyse the technical modification of the ALPPS procedure, ligating the middle hepatic vein during the first step of the operation to enhance remnant liver hypertrophy. Methods In 20 of 37 ALPPS procedures, the middle hepatic vein was ligated during the first step. Hypertrophy of the functional remnant liver volume was assessed in addition to postoperative courses. Results Volumetric analysis showed a significant volume increase, especially for patients with colorectal metastases. Pre-existing liver parenchyma damage (odds ratio = 0.717, p = 0.017) and preoperative chemotherapy were found to be significant predictors (odds ratio = 0.803, p = 0.045) of higher morbidity and mortality. In addition, a survival benefit for maintenance of middle hepatic vein was shown. Conclusion This technical modification of the ALPPS procedure can accentuate future liver remnant volume hypertrophy. The higher morbidity and mortality observed are most likely associated with pre-existing parenchymal damage within this group.

Vessel-Guided Mesohepatectomy for Liver Partition and Staged Major Parenchyma-Sparing Hepatectomies with Super-Selective Portal Vein Embolization or Enhanced ALPPS to Achieve R0 Resection for Colorectal Liver Metastases at the Hepatocaval Confluence

“…To date, in our institution, liver function evaluation with 99mTc-mebrofenin hepatobiliary scintigraphy is not available and liver volume is still the way to determine the adequate FLR [32]. In two cases of e-ALPPS (Figures 10-13), adequate FLR was not achieved after the first stage despite MHV resection, which is considered a procedure accentuating FLR volume hypertrophy [33]. Our MDT, observing FLR volume increase after the resection of embolized liver in PS-TSH with SS-PVE, proposed the partial resection of deportalized liver as a boost for FLR regeneration up to the adequate volume.…”