Predicción del crecimiento hepático tras ALPPSanálisis multicéntrico del registro internacional de ALPPS

Resumen

Liver growth after associated liver partition and portal vein ligation for two staged hepatectomy (ALPPS) depends on several already known clinical factors, such as the type of tumor or the age of the patient, but it is still unclear which factors are most important to achieve accelerated hypertrophy within a short period of time, since there are patients who achieve the desired regeneration in less than two weeks or others in a longer period of time. Most publications, so far, have focused on the impact of the perioperative complications, but the prediction of liver growth has been less studied. The objective of this study is, therefore, to identify patient-intrinsic factors related to the growth of the liver remnant in patients undergoing ALPPS. Objectives: The main objective of the study is to analyze the anthropometric data of the patients, the type of tumor and the intraoperative results in the growth of the future liver remnant. Material and methods: An analytical observational study has been carried out on a cohort of patients from the International Registry of ALPPS, who have been divided into three groups depending on the time in which a sufficient future remaining liver volume is achieved: less than 1 week, between 1 and 2 weeks, and more than 2 weeks. Results: 734 patients who underwent ALPPS between November 2011 and October 2018 in 99 different centers were included in the study. The average age of the patients was 60 years, 61% of them were men, with a BMI of 25 Kg/m2. The most common surgical indication was colorectal cancer metastases (65.1%), followed by hepatocellular carcinoma (13.4%). The median increase in standardized remaining liver volume was 0.15 (IQR: 0.1–0.2). The variables associated with a lower increase in standardized remaining liver volume were age greater than 68 years (p=0.02), height greater than 1.76 m (p smaller than 0.01), weight greater than 83 kg (p smaller than 0.01), BMI greater than 28 (p smaller than 0.01), male sex (p smaller than 0.01), antihypertensive treatment (p smaller than 0.01), operation time greater than 370 minutes (p smaller than 0.01) and hospital stay greater than 14 days (p smaller than 0.01). Conclusions: Height, weight and sex are the variables that most constantly influence both the percentage increase in liver volume between both stages of ALPPS and liver growth before the second surgery. Other variables such as surgical time, postoperative complications or hospital stay impact both the time interval between both ALPPS surgeries and the failure to reach the second stage. Findings such as the negative effect of antihypertensive drugs or chronic renal failure on liver regeneration represent a novelty that had not been described, and require more studies to know the true extent of their impact.