Liver Resection Promotes Long-Term Survival

A new study shows that in situ split (ISS) liver resection can provide long-term survival for patients with advanced liver malignancies.

Researchers at University Hospital Regensburg (Germany) conducted a study that retrospectively analyzed 16 patients who underwent ISS liver resection between 2007 and 2014. The procedure involves a novel method to induce rapid hypertrophy of the contra-lateral liver lobe, and is intended for patients at risk of postoperative liver failure due to an insufficient amount of liver tissue remaining after the resection. Two patients were lost in early postoperative phase (90 days), and one was lost during follow-up.

Of the remaining 13 patients with a follow-up period of more than 3 months, seven suffered from colorectal liver metastases (CRLM), and six from various other liver malignancies (non-CRLM). The ISS procedure resulted in a median increase of 86.3% of the left lateral liver lobe after a median time period of nine days. The median disease-free survival (DFS) time was 14.6 months, and the median overall survival was 41.7 months (reduced to 26.4 months when including 90-days mortality). The three-year survival rate was 64.3% for the CRLM and 50% for the non-CRLM patients. The study was published in the February 2015 issue of Langenbeck's Archives of Surgery.

“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,” concluded lead author Sven Lang, MD, and colleagues. “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.”

ISS, also known as associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) combines portal vein ligation and complete parenchymal transaction, splitting the lobe along the right side of the falciform ligament. After a median of nine days, the segments increase by about 75%, allowing for the subsequent hepatectomy.

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