title: Impact of Neoadjuvant Chemotherapy on Hypertrophy of the Future Liver Remnant after Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy.
abstract: BACKGROUND
  Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been demonstrated as a feasible procedure in extended liver resections as a means of successfully increasing the volume of the future liver remnant (FLR). Neoadjuvant chemotherapy (CTx) is toxic to the organ and may impair hepatic regeneration. This study was performed to assess the procedure's effect on hypertrophy of the FLR, including the short-term survival.
  
  
  METHODS
  We analyzed 19 consecutive ALPPS patients, of whom 58% (n = 11) received neoadjuvant CTx because of colorectal liver metastasis (CRM). Patients presented with multifocal CRM (n = 11, 58%); cholangiocarcinoma (n = 7, 37%), of which 5 were in the Klatskin position; and gallbladder carcinoma (n = 1, 5%). Hepatectomy was performed within 6 to 13 days after hepatic partition. Volumetry was performed before both liver partitioning and hepatectomy. A survival analysis was performed.
  
  
  RESULTS
  Liver partition and portal vein ligation induced sufficient hypertrophy of the FLR, with an increased volume of 74% ± 35%. Patients underwent hepatectomy after a median of 8 days; in all cases R0 resection was achieved. Neoadjuvant CTx was shown to significantly impair hypertrophy. The volume of the FLR in non-CTx patients increased by 98% ± 35%; an increase of 59% ± 22% was observed in patients who underwent CTx (p = 0.027). Chemotherapy did not have an impact on either morbidity or in-hospital mortality, which were 68% and 16%, respectively. One-year overall survival was 53%, with a 1-year survival of 67% in CRM patients and 38% in non-CRM patients (p > 0.05).
  
  
  CONCLUSIONS
  Data presented here demonstrate for the first time that neoadjuvant CTx significantly impairs hypertrophy of the FLR after ALPPS.
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kremer
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Germany.
authors.forename: Giulia
authors.initials: G
authors.lastname: Manzini
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Germany.
authors.forename: Branimir
authors.initials: B
authors.lastname: Hristov
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Polychronidis
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.
authors.forename: Theresa
authors.initials: T
authors.lastname: Mokry
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Sommer
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Germany.
authors.forename: Arianeb
authors.initials: A
authors.lastname: Mehrabi
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Germany.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Germany. Electronic address: Peter.Schemmer@med.uni-heidelberg.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D004067:Digestive System Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008026:Ligation; D008099:Liver / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D008115:Liver Regeneration / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D009929:Organ Size; D011169:Portal Vein / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents