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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.

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Title: Rapid induction of liver regeneration for major hepatectomy (REBIRTH): A randomized controlled trial of portal vein embolisation versus ALPPS assisted with radiofrequency.
Authors: Jiao, LR
Fajardo Puerta, AB
Gall, TMH
Sodergren, MH
Frampton, AE
Pencavel, T
Nagendran, M
Habib, NA
Darzi, A
Pai, M
Thomas, R
Tait, P
Item Type: Journal Article
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) ≤25% (or ≤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 ± 13.7% after a median 20 days following RALPPS compared to 18.4 ± 9.8% after 35 days (p < 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.
Issue Date: 4-Mar-2019
Date of Acceptance: 26-Feb-2019
URI: http://hdl.handle.net/10044/1/69022
DOI: https://dx.doi.org/10.3390/cancers11030302
ISSN: 2072-6694
Publisher: MDPI AG
Journal / Book Title: Cancers
Volume: 11
Issue: 3
Copyright Statement: © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Sponsor/Funder: Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: RDB04 79560
RD207
Keywords: ALPPS
ALPPS-RF
RALPPS
hepatic resection
portal vein embolisation
portal vein ligation
Publication Status: Published
Conference Place: Switzerland
Article Number: 302
Online Publication Date: 2019-03-04
Appears in Collections:Division of Surgery
Division of Cancer



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