Moderating postoperative pancreatic fistula achieved by selective use of pancreaticogastrostomy

Abstract

Background: Different surgical strategies are used for prevention of posthepatectomy liver failure. Aim of the study was to compare of radiofrequensy ALLPS(-RALLPS), PVE and PVL in prevention of posthepatectomy liver failure in single center. Methods: In Moscow Clinical Scientific Center(between January 2014 and December 2016) 23 PVE, 7 PVL, 8 RALPPS (3 RALLPS+PVL and 5 transcutaneous RALLPS +PVE) patients(pts) were included. Indication for PVE were less than 30% (normal liver), or 40% (cirrhotic liver) preoperative estimated future liver remnant (FLR). Indications for ALPPS/RALPPS were: very small FLR (less than 20%). CT volumetry and 99m Tc-Mebrofenin SPECT/ CT were performed to estimate FLR volume and function. Results: Duration after first stage was significantly shorter in RALPPS (10 days) in comparison with two-stage hepatectomy with PVE (29 days) and PVL(35 days). The rate of hypertrophy of FRL was significantly higher after first stage of RALPPS (66.3%) in comparison with PVE (27.2%) and PVL(20%). Tumor progression was revealed in 7 (30%) pts after PVE, in 3(42%) and in 0 (0%) after RALPPS (p>0.05). Liver failure according to ISGLS criteria was revealed in 5 (22%) pts after PVE (grade А, В), 1(12,5%) after PVL(Grade B) and 1 (12,5%) pts after RALPPS (grade В) without significant differences (p>0,05). Conclusion: Variants of RALPPS are effective in prevention of posthepatectomy liver failure with lower rate of morbidity and tumor progression comparable with twostage hepatecomies.