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Background <p>Optimizing future liver remnant (FLR) volumes is crucial for safe major liver resections; liver venous deprivation (LVD) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) variants (vALPPS) are widely used techniques to address this issue, but direct comparisons are limited. The study aimed to evaluate their perioperative and oncological outcomes.</p> Patients and Methods <p>This was a retrospective cohort study on consecutive patients undergoing liver hypertrophy between January 2015 and July 2024 conducted at two referral centers. A total of 84 patients, according to exclusion criteria, completed the procedure (drop-out rate: 21.1%)—28 tourniquet-ALPPS (T-ALPPS), 22 hybrid-ALPPS (H-ALPPS) and 34 LVD. Clinical, surgical, and oncological variables were analyzed on the overall and colorectal liver metastases (CRLM) populations.</p> Results <p>T-ALPPS group included more CRLM (92.9% vs 50% vs 38.2%, <i>p</i> &lt; 0.001) and achieved faster hypertrophy (28.5 vs 37 vs 47.5 days, <i>p</i> = 0.004), although pre- and post-hypertrophy techniques volumes were comparable (pre-sFLR ~28%; post-SFLR ~40%). Minimally invasive approach predominated in the LVD group (67.6% vs 27.3% vs 3.6%, <i>p</i> &lt; 0.001) but implied longer operative times (426 vs 242 vs 180 min, <i>p</i> &lt; 0.001). No significant differences in major complications (CD ≥ 3A), 90-day mortality, non-radical resections rates, DFS, and OS were found. In CRLM subgroup, T-ALPPS achieved higher and faster hypertrophy, while LVD presented fewer major complications rate and no 90-day mortality. Very early recurrence rate (&lt; 6 months) was higher in the LVD group, but DFS and OS were comparable.</p> Conclusions <p>vALPPS and LVD represent valid hypertrophy techniques, the first enabling faster regeneration and the latter allowing for more minimally invasive approaches. The choice of approach should be individualized on the basis of tumor biology, patient condition, and institutional expertise.</p>

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Hepatic Hypertrophy Techniques: Comparing Perioperative Outcomes of Liver Venous Deprivation (LVD) and Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy-Variants (vALPPS) Among Two Referral Centers

  • 期刊论文

  • 发表日期：

    2025年11月6日

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  • Cecilia Maina,
  • Victor López-López,
  • Francesca Ratti,
  • Domenico Santangelo,
  • Beatrice Radaelli,
  • Álvaro Navarro-Barrios,
  • Roberto Brusadin,
  • José Ignacio Tudela-Martinez,
  • Guillermo Carbonell,
  • Francesco De Cobelli,
  • Luca Aldrighetti,
  • Ricardo Robles-Campos

摘要

Background

Optimizing future liver remnant (FLR) volumes is crucial for safe major liver resections; liver venous deprivation (LVD) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) variants (vALPPS) are widely used techniques to address this issue, but direct comparisons are limited. The study aimed to evaluate their perioperative and oncological outcomes.

Patients and Methods

This was a retrospective cohort study on consecutive patients undergoing liver hypertrophy between January 2015 and July 2024 conducted at two referral centers. A total of 84 patients, according to exclusion criteria, completed the procedure (drop-out rate: 21.1%)—28 tourniquet-ALPPS (T-ALPPS), 22 hybrid-ALPPS (H-ALPPS) and 34 LVD. Clinical, surgical, and oncological variables were analyzed on the overall and colorectal liver metastases (CRLM) populations.

Results

T-ALPPS group included more CRLM (92.9% vs 50% vs 38.2%, p < 0.001) and achieved faster hypertrophy (28.5 vs 37 vs 47.5 days, p = 0.004), although pre- and post-hypertrophy techniques volumes were comparable (pre-sFLR ~28%; post-SFLR ~40%). Minimally invasive approach predominated in the LVD group (67.6% vs 27.3% vs 3.6%, p < 0.001) but implied longer operative times (426 vs 242 vs 180 min, p < 0.001). No significant differences in major complications (CD ≥ 3A), 90-day mortality, non-radical resections rates, DFS, and OS were found. In CRLM subgroup, T-ALPPS achieved higher and faster hypertrophy, while LVD presented fewer major complications rate and no 90-day mortality. Very early recurrence rate (< 6 months) was higher in the LVD group, but DFS and OS were comparable.

Conclusions

vALPPS and LVD represent valid hypertrophy techniques, the first enabling faster regeneration and the latter allowing for more minimally invasive approaches. The choice of approach should be individualized on the basis of tumor biology, patient condition, and institutional expertise.