Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Dec;42(12):2815-2829.
doi: 10.1111/liv.15287. Epub 2022 May 26.

Liver growth prediction in ALPPS - A multicenter analysis from the international ALPPS registry

Victor Lopez-Lopez  1 , Michael Linecker  2 , Juan Cruz  3 , Roberto Brusadin  1 , Asuncion Lopez-Conesa  1 , Marcel Autran Machado  4 , Roberto Hernandez-Alejandro  5 , Alejandro Sergey Voskanyan  6 , Jun Li  7 , Deniz Balci  8 , René Adam  9 , Victoria Ardiles  10 , Eduardo De Santibañes  10 , Federico Tomassini  11 , Roberto I Troisi  12 , Georg Lurje  13 , Stéphanie Truant  14 , Francois-René Pruvot  14 , Bergthor Björnsson  15 , Miroslav Stojanovic  16 , Roberto Montalti  12 , Valentin Cayuela  1 , Ivan Kozyrin  17 , Xiujun Cai  18 , Emilio de Vicente  19 , Falk Rauchfuss  20 , Peter Lodge  21 , Francesca Ratti  22 , Luca Aldrighetti  22 , Karl J Oldhafer  23 , Massimo Malago  24 , Henrik Petrowsky  25 , Pierre-Alain Clavien  25 , Ricardo Robles-Campos  1
Affiliations
Multicenter Study

Liver growth prediction in ALPPS - A multicenter analysis from the international ALPPS registry

Victor Lopez-Lopez et al. Liver Int. 2022 Dec.

Abstract

Background: While ALPPS triggers a fast liver hypertrophy, it is still unclear which factors matter most to achieve accelerated hypertrophy within a short period of time. The aim of the study was to identify patient-intrinsic factors related to the growth of the future liver remnant (FLR).

Methods: This cohort study is composed of data derived from the International ALPPS Registry from November 2011 and October 2018. We analyse the influence of demographic, tumour type and perioperative data on the growth of the FLR. The volume of the FLR was calculated in millilitre and percentage using computed-tomography (CT) scans before and after stage 1, both according to Vauthey formula.

Results: A total of 734 patients were included from 99 centres. The median sFLR at stage 1 and stage 2 was 0.23 (IQR, 0.18-0.28) and 0.39 (IQR: 0.31-0.46), respectively. The variables associated with a lower increase from sFLR1 to sFLR2 were age˃68 years (p = .02), height ˃1.76 m (p ˂ .01), weight ˃83 kg (p ˂ .01), BMI˃28 (p ˂ .01), male gender (p ˂ .01), antihypertensive therapy (p ˂ .01), operation time ˃370 minutes (p ˂ .01) and hospital stay˃14 days (p ˂ .01). The time required to reach sufficient volume for stage 2, male gender accounts 40.3% in group ˂7 days, compared with 50% of female, and female present 15.3% in group ˃14 days compared with 20.6% of male.

Conclusions: Height, weight, FLR size and gender could be the variables that most constantly influence both daily growths, the interstage increase and the standardized FLR before the second stage.

Keywords: ALPPS; anthropometrics; liver cancer; liver regeneration; rapid hypertrophy.

PubMed Disclaimer

Conflict of interest statement

There is no conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1
Growth patterns between sFLR1 and sFLR2 as a function of age (A), weight (B) and gender (C)
FIGURE 2
FIGURE 2
Gender influence on the time required to reach sufficient volume for the second intervention in less than 7 days, between 7 and 14 days and more than 14 days
FIGURE 3
FIGURE 3
Visualizations about the relationship of age (A), weight (B) and gender (C) in the daily growth of the FLR according to the mixed linear model. Correlations between variables gender‐age (D), gender‐weight (E) and age‐weight (F)
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

References

    1. Heinrich S, Lang H. Hepatic resection for primary and secondary liver malignancies. Innov Surg Sci. 2017;2(1):1‐8. - PMC - PubMed
    1. Aloia TA, Fahy BN, Fischer CP, et al. Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB (Oxford). 2009;11(6):510‐515. - PMC - PubMed
    1. Adam R, Imai K, Castro Benitez C, et al. Outcome after associating liver partition and portal vein ligation for staged hepatectomy and conventional two‐stage hepatectomy for colorectal liver metastases. Br J Surg. 2016;103(11):1521‐1529. - PubMed
    1. Pawlik TM, Schulick RD, Choti MA. Expanding criteria for resectability of colorectal liver metastases. Oncologist. 2008;13(1):51‐64. - PubMed
    1. Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2‐staged extended right hepatic resection in small‐for‐size settings. Ann Surg. 2012;255(3):405‐414. - PubMed

Publication types