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Rapid Induction of Liver Regeneration for Major Hepatectomy (REBIRTH): A Randomized Controlled Trial of Portal Vein Embolisation versus ALPPS Assisted with Radiofrequency

Authors :
Ana B Fajardo Puerta
Adam E Frampton
Nagy A. Habib
Paul Tait
Mikael H. Sodergren
Ara Darzi
Myura Nagendran
Long R. Jiao
Madhava Pai
Tamara Gall
Robert J. Thomas
Tim D. Pencavel
Imperial College Healthcare NHS Trust- BRC Funding
Source :
Cancers, Cancers, Vol 11, Iss 3, p 302 (2019), Volume 11, Issue 3
Publication Year :
2019
Publisher :
MDPI AG, 2019.

Abstract

To avoid liver insufficiency following major hepatic resection, portal vein embolisation (PVE) is used to induce liver hypertrophy pre-operatively. Associating liver partition with portal vein ligation for staged hepatectomy assisted with radiofrequency (RALPPS) was introduced as an alternative method. A randomized controlled trial comparing PVE with RALPPS for the pre-operative manipulation of liver volume in patients with a future liver remnant volume (FLRV) &le<br />25% (or &le<br />35% if receiving preoperative chemotherapy) was conducted. The primary endpoint was increase in size of the FLRV. The secondary endpoints were length of time taken for the volume gain, morbidity, operation length and post-operative liver function. Between July 2015 and October 2017, 57 patients were randomised to RALPPS (n = 29) and PVE (n = 28). The mean percentage of increase in the FLRV was 80.7 &plusmn<br />13.7% after a median 20 days following RALPPS compared to 18.4 &plusmn<br />9.8% after 35 days (p &lt<br />0.001) following PVE. Twenty-four patients after RALPPS and 21 after PVE underwent stage-2 operation. Final resection was achieved in 92.3% and 66.6% patients in RALPPS and PVE, respectively (p = 0.007). There was no difference in morbidity, and one 30-day mortality after RALPPS (p = 0.991) was reported. RALPPS is more effective than PVE in increasing FLRV and the number of patients for surgical resection.

Details

ISSN :
20726694
Volume :
11
Database :
OpenAIRE
Journal :
Cancers
Accession number :
edsair.doi.dedup.....b57982c086f876b57624a6e0c53cd5c9
Full Text :
https://doi.org/10.3390/cancers11030302