Abstract
Purpose
In-situ split (ISS) liver resection is a novel method to induce rapid hypertrophy of the contralateral liver lobe in patients at risk for postoperative liver failure due to insufficient liver remnant. So far, no data about oncological long-term survival after ISS liver resection is available.
Methods
We retrospectively analyzed our patients treated with ISS liver resection at the Department of Surgery of the University of Regensburg, the first center worldwide to perform ISS.
Results
Between 2007 and 2014, ISS liver resection was performed in 16 patients. Two patients (12.5 %) were lost in early postoperative phase (90 days) and one was lost to follow-up. Thirteen patients with a follow-up period of more than 3 months were included into oncologically focused analyses. Median follow-up was 26.4 months (range 3.2–54.6). Seven patients had suffered from colorectal liver metastases (CRLM) and six from various other liver malignancies (non-CRLM). The ISS procedure had led to a median increase of 86.3 % of the left lateral liver lobe after a median of 9 days (range 4–28 days). Median disease-free survival (DFS) was 14.6 months and median overall survival (OS) was 41.7 months (26.4 months when including 90-days mortality). Three-year survival was calculated with 56.4 and 48.9 % when including perioperative mortality, respectively (CRLM 64.3 % vs. non-CRLM 50 %).
Conclusion
ISS liver resection can provide long-term survival of selected patients with advanced liver malignancies that otherwise are not eligible for liver resection due to insufficient liver remnant.
Similar content being viewed by others
References
Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239(6):818–825, discussion 825-817
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230(3):309–318, discussion 318-321
Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, Jaeck D (1996) Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Assoc Fr Chir Cancer 77(7):1254–1262
Rees M, Tekkis PP, Welsh FK, O'Rourke T, John TG (2008) Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 247(1):125–135
Bachellier P, Rosso E, Pessaux P, Oussoultzoglou E, Nobili C, Panaro F, Jaeck D (2011) Risk factors for liver failure and mortality after hepatectomy associated with portal vein resection. Ann Surg 253(1):173–179
Mathur AK, Ghaferi AA, Osborne NH, Pawlik TM, Campbell DA, Englesbe MJ, Welling TH (2010) Body mass index and adverse perioperative outcomes following hepatic resection. J Gastrointest Surg 14(8):1285–1291
Wicherts DA, de Haas RJ, Andreani P, Ariche A, Salloum C, Pascal G, Castaing D, Adam R, Azoulay D (2011) Short- and long-term results of extended left hepatectomy for colorectal metastases. HPB (Oxford) 13(8):536–543. doi:10.1111/j.1477-2574.2011.00321.x
Truant S, Oberlin O, Sergent G, Lebuffe G, Gambiez L, Ernst O, Pruvot FR (2007) Remnant liver volume to body weight ratio > or =0.5 %: A new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver. J Am Coll Surg 204(1):22–33
Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN (2002) Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 137(6):675–680, discussion 680-671
Hemming AW, Reed AI, Howard RJ, Fujita S, Hochwald SN, Caridi JG, Hawkins IF, Vauthey JN (2003) Preoperative portal vein embolization for extended hepatectomy. Ann Surg 237(5):686–691, discussion 691-683
Shimada H, Tanaka K, Matsuo K, Togo S (2006) Treatment for multiple bilobar liver metastases of colorectal cancer. Langenbeck‘s Arch Surg 391(2):130–142
Jaeck D, Oussoultzoglou E, Rosso E, Greget M, Weber JC, Bachellier P (2004) A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg 240(6):1037–1049, discussion 1049-1051
Chua TC, Liauw W, Chu F, Morris DL (2013) Summary outcomes of two-stage resection for advanced colorectal liver metastases. J Surg Oncol 107(2):211–216
Schnitzbauer AA, Lang SA, Goessmann H, Nadalin S, Baumgart J, Farkas SA, Fichtner-Feigl S, Lorf T, Goralcyk A, Horbelt R, Kroemer A, Loss M, Rummele P, Scherer MN, Padberg W, Konigsrainer A, Lang H, Obed A, Schlitt HJ (2012) Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 255(3):405–414
Lang SA, Loss M, Schlitt HJ (2014) "In-situ Split" (ISS) Liver resection: new aspects of technique and indication. Zentralbl Chir 139(2):212–219
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Lam VW, Laurence JM, Johnston E, Hollands MJ, Pleass HC, Richardson AJ (2013) A systematic review of two-stage hepatectomy in patients with initially unresectable colorectal liver metastases. HPB (Oxford) 15(7):483–491
Schadde E, Ardiles V, Slankamenac K, Tschuor C, Sergeant G, Amacker N, Baumgart J, Croome K, Hernandez-Alejandro R, Lang H, de Santibanes E, Clavien PA (2014) ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis. World J Surg 38(6):1510–1519
Shindoh J, Tzeng CW, Aloia TA, Curley SA, Huang SY, Mahvash A, Gupta S, Wallace MJ, Vauthey JN (2014) Safety and efficacy of portal vein embolization before planned major or extended hepatectomy: an institutional experience of 358 patients. J Gastrointest Surg 18(1):45–51
Alvarez FA, Ardiles V, Sanchez Claria R, Pekolj J, de Santibanes E (2013) Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks. J Gastrointest Surg 17(4):814–821
Knoefel WT, Gabor I, Rehders A, Alexander A, Krausch M, Schulte am Esch J, Furst G, Topp SA (2013) In situ liver transection with portal vein ligation for rapid growth of the future liver remnant in two-stage liver resection. Br J Surg 100(3):388–394
Li J, Girotti P, Konigsrainer I, Ladurner R, Konigsrainer A, Nadalin S (2013) ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure? J Gastrointest Surg 17(5):956–961
Oldhafer KJ, Donati M, Jenner RM, Stang A, Stavrou GA (2014) ALPPS for patients with colorectal liver metastases: effective liver hypertrophy, but early tumor recurrence. World J Surg 38(6):1504–1509
Sala S, Ardiles V, Ulla M, Alvarez F, Pekolj J, de Santibanes E (2012) Our initial experience with ALPPS technique: encouraging results. Updat Surg 64(3):167–172
Torres OJ, Fernandes Ede S, Oliveira CV, Lima CX, Waechter FL, Moraes-Junior JM, Linhares MM, Pinto RD, Herman P, Machado MA (2013) Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): the Brazilian experience. Arq Bras Cir Dig 26(1):40–43
Chen X, Li B, He W, Wei YG, Du ZG, Jiang L (2014) Mesohepatectomy versus extended hemihepatectomy for centrally located hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 13(3):264–270
Shindoh J, Tzeng CW, Aloia TA, Curley SA, Zimmitti G, Wei SH, Huang SY, Gupta S, Wallace MJ, Vauthey JN (2013) Portal vein embolization improves rate of resection of extensive colorectal liver metastases without worsening survival. Br J Surg 100(13):1777–1783
Wicherts DA, Miller R, de Haas RJ, Bitsakou G, Vibert E, Veilhan LA, Azoulay D, Bismuth H, Castaing D, Adam R (2008) Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg 248(6):994–1005
Hoekstra LT, van Lienden KP, Doets A, Busch OR, Gouma DJ, van Gulik TM (2012) Tumor progression after preoperative portal vein embolization. Ann Surg 256(5):812–817, discussion 817-818
Hayashi S, Baba Y, Ueno K, Nakajo M, Kubo F, Ueno S, Aikou T, Komokata T, Nakamura N, Sakata R (2007) Acceleration of primary liver tumor growth rate in embolized hepatic lobe after portal vein embolization. Acta Radiol 48(7):721–727
Ye LC, Liu TS, Ren L, Wei Y, Zhu DX, Zai SY, Ye QH, Yu Y, Xu B, Qin XY, Xu J (2013) Randomized controlled trial of cetuximab plus chemotherapy for patients with KRAS wild-type unresectable colorectal liver-limited metastases. J Clin Oncol 31(16):1931–1938
Brouquet A, Abdalla EK, Kopetz S, Garrett CR, Overman MJ, Eng C, Andreou A, Loyer EM, Madoff DC, Curley SA, Vauthey JN (2011) High survival rate after two-stage resection of advanced colorectal liver metastases: response-based selection and complete resection define outcome. J Clin Oncol 29(8):1083–1090
Yamashita S, Hasegawa K, Takahashi M, Inoue Y, Sakamoto Y, Aoki T, Sugawara Y, Kokudo N (2013) One-stage hepatectomy following portal vein embolization for colorectal liver metastasis. World J Surg 37(3):622–628
Shindoh J, Vauthey JN, Zimmitti G, Curley SA, Huang SY, Mahvash A, Gupta S, Wallace MJ, Aloia TA (2013) 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. J Am Coll Surg 217(1):126–133, discussion 133-124
Authors’ contributions
Lang, Loss, and Schlitt were incharged for the study conception and design; Lang and Benseler for the acquisition of data; Lang, Glockzin, and Schlitt for the analysis and interpretation of data; Lang for drafting of the manuscript; and Lang, Loss, and Schlitt for the critical revision of manuscript.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lang, S.A., Loss, M., Benseler, V. et al. Long-term results after in-situ split (ISS) liver resection. Langenbecks Arch Surg 400, 361–369 (2015). https://doi.org/10.1007/s00423-015-1285-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-015-1285-z