Multimodale Leberaugmentationstechniken (Portalvenenembolisation, Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy) und Volumen-/Funktionsplanung

Einleitung

Vor leberchirurgischen Eingriffen gilt es, folgende grundsätzliche Frage zu adressieren und bestmöglich abzuschätzen:

Ist das zu erwartende onkochirurgisch notwendige Resektionsausmaß auch für den Patienten verträglich?

Verbesserte operative und intensivmedizinische Techniken ermöglichen die Durchführung immer ausgedehnterer Leberteilresektionen (LR). Trotz dieses Fortschritts stellt das postoperativ auftretende Leberversagen (PLV) sowie die hiermit assoziierte Sterblichkeit unverändert ein relevantes Problem dar.

• Literatur

• 1 Balzan S, Belghiti J, Farges O. et al. The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 2005; 242: 824-828
• 2 van den Broek MA, Olde Damink SW, Dejong CH. et al. Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int 2008; 28: 767-780
• 3 Kishi Y, Abdalla EK, Chun YS. et al. Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry. Ann Surg 2009; 250: 540-548
• 4 Higuchi R, Yamamoto M. Indications for portal vein embolization in perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci 2014; 21: 542-549
• 5 Madoff DC, Abdalla EK, Gupta S. et al. Transhepatic ipsilateral right portal vein embolization extended to segment IV: improving hypertrophy and resection outcomes with spherical particles and coils. J Vasc Interv Radiol 2005; 16: 215-225
• 6 Garcia-Perez R, Revilla-Nuin B, Martinez CM. et al. Associated liver partition and portal vein ligation (ALPPS) vs. selective portal vein ligation (PVL) for staged hepatectomy in a rat model. similar regenerative response?. PLoS One 2015; 10: e0144096
• 7 am Esch JS, Schmelzle M, Fürst G. et al. Infusion of CD133+ bone marrow-derived stem cells after selective portal vein embolization enhances functional hepatic reserves after extended right hepatectomy: a retrospective single-center study. Ann Surg 2012; 255: 79-85
• 8 Malinowski M, Stary V, Lock JF. et al. Factors influencing hypertrophy of the left lateral liver lobe after portal vein embolization. Langenbecks Arch Surg 2015; 400: 237-246
• 9 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: 405-414
• 10 Eshmuminov D, Raptis DA, Linecker M. et al. Meta-analysis of associating liver partition with portal vein ligation and portal vein occlusion for two-stage hepatectomy. Br J Surg 2016; 103: 1768-1782
• 11 Stockmann M, Lock JF, Malinowski M. et al. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford) 2010; 12: 139-146
• 12 Stockmann M, Bednarsch J, Malinowski M. et al. Functional considerations in ALPPS – consequences for clinical management. HPB (Oxford) 2017;
• 13 Stockmann M, Lock JF, Malinowski M. et al. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford) 2010; 12: 139-146
• 14 Jara M, Reese T, Malinowski M. et al. Reductions in post-hepatectomy liver failure and related mortality after implementation of the LiMAx algorithm in preoperative work-up: a single-centre analysis of 1170 hepatectomies of one or more segments. HPB (Oxford) 2015; 17: 651-658