Negative impact of chemotherapy on kinetic growth rate of the future liver remnant if applied following PVE or ALPPS.
<h4>Purpose</h4>Modern liver surgery has improved the percentage of potentially resectable malignant tumors. However, if the future liver remnant is small, patients remain at risk of developing postoperative liver failure. Thus, the future liver remnant must be increased, while at the sa...
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Public Library of Science (PLoS)
2025-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0307937 |
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| author | Klara Welcker Martin A Schneider Tim Reese Andrea Ehrenfeld Hauke Weilert Axel Stang Peter Wohlmuth Mia-Maria Warnke Carolin Reiner Thomas von Hahn Karl J Oldhafer Andreas H Mahnken Roland Brüning |
| author_facet | Klara Welcker Martin A Schneider Tim Reese Andrea Ehrenfeld Hauke Weilert Axel Stang Peter Wohlmuth Mia-Maria Warnke Carolin Reiner Thomas von Hahn Karl J Oldhafer Andreas H Mahnken Roland Brüning |
| author_sort | Klara Welcker |
| collection | DOAJ |
| description | <h4>Purpose</h4>Modern liver surgery has improved the percentage of potentially resectable malignant tumors. However, if the future liver remnant is small, patients remain at risk of developing postoperative liver failure. Thus, the future liver remnant must be increased, while at the same time, the primary tumor may have to be controlled by chemotherapy. To address this conflict, we retrospectively analyzed the changes in hypertrophy before and after Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) or Portal Vein Embolization (PVE), with or without parallel systemic chemotherapy.<h4>Materials and methods</h4>We retrospectively analysed 172 patients (54 female and 118 male), treated with ALPPS in 90 patients (median age 61 years [Q1, Q3: 52,71]) and with PVE in 82 patients (median age 66 years [Q1, Q3: 56,73]). The median control interval was 4.9 [Q1, Q3: 4.0, 6.0] weeks after the PVE, and 2.6 [Q1, Q3: 1.6, 5.8] weeks after ALPPS step 1.<h4>Results</h4>The overall kinetic growth rate (median) for the entire group was 0.02 (2%) per week. When systemic chemotherapy was administered prior to intervention, the kinetic growth rate of these treated patients (vs. untreated) exhibited a median of 0.020 [Q1, Q3: 0.011, 0.067] compared to 0.024 [Q1, Q3: 0.013, 0.041] (p = 0.949). When chemotherapy was administered after the PVE/ ALPPS treatment, the kinetic growth rate declined from a median of 0.025 [Q1, Q3: 0.013, 0.053] to 0.011 [Q1, Q3: 0.007, 0.021] (p = 0.005). Subgroup analysis showed statistically significant effects only in the PVE group (median ALPPS -45% (p = 0.157), PVE -47% (p = 0.005)).<h4>Conclusion</h4>This retrospective analysis indicated that systemic chemotherapy given after PVE/ the first step of the ALPPS procedure, i.e., the growth phase, has a negative effect on the kinetic growth rate. |
| format | Article |
| id | doaj-art-5d38690a3e96427bb8eb7722f0364893 |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-5d38690a3e96427bb8eb7722f03648932025-08-20T03:52:46ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01203e030793710.1371/journal.pone.0307937Negative impact of chemotherapy on kinetic growth rate of the future liver remnant if applied following PVE or ALPPS.Klara WelckerMartin A SchneiderTim ReeseAndrea EhrenfeldHauke WeilertAxel StangPeter WohlmuthMia-Maria WarnkeCarolin ReinerThomas von HahnKarl J OldhaferAndreas H MahnkenRoland Brüning<h4>Purpose</h4>Modern liver surgery has improved the percentage of potentially resectable malignant tumors. However, if the future liver remnant is small, patients remain at risk of developing postoperative liver failure. Thus, the future liver remnant must be increased, while at the same time, the primary tumor may have to be controlled by chemotherapy. To address this conflict, we retrospectively analyzed the changes in hypertrophy before and after Associating Liver Partition with Portal vein ligation for Staged hepatectomy (ALPPS) or Portal Vein Embolization (PVE), with or without parallel systemic chemotherapy.<h4>Materials and methods</h4>We retrospectively analysed 172 patients (54 female and 118 male), treated with ALPPS in 90 patients (median age 61 years [Q1, Q3: 52,71]) and with PVE in 82 patients (median age 66 years [Q1, Q3: 56,73]). The median control interval was 4.9 [Q1, Q3: 4.0, 6.0] weeks after the PVE, and 2.6 [Q1, Q3: 1.6, 5.8] weeks after ALPPS step 1.<h4>Results</h4>The overall kinetic growth rate (median) for the entire group was 0.02 (2%) per week. When systemic chemotherapy was administered prior to intervention, the kinetic growth rate of these treated patients (vs. untreated) exhibited a median of 0.020 [Q1, Q3: 0.011, 0.067] compared to 0.024 [Q1, Q3: 0.013, 0.041] (p = 0.949). When chemotherapy was administered after the PVE/ ALPPS treatment, the kinetic growth rate declined from a median of 0.025 [Q1, Q3: 0.013, 0.053] to 0.011 [Q1, Q3: 0.007, 0.021] (p = 0.005). Subgroup analysis showed statistically significant effects only in the PVE group (median ALPPS -45% (p = 0.157), PVE -47% (p = 0.005)).<h4>Conclusion</h4>This retrospective analysis indicated that systemic chemotherapy given after PVE/ the first step of the ALPPS procedure, i.e., the growth phase, has a negative effect on the kinetic growth rate.https://doi.org/10.1371/journal.pone.0307937 |
| spellingShingle | Klara Welcker Martin A Schneider Tim Reese Andrea Ehrenfeld Hauke Weilert Axel Stang Peter Wohlmuth Mia-Maria Warnke Carolin Reiner Thomas von Hahn Karl J Oldhafer Andreas H Mahnken Roland Brüning Negative impact of chemotherapy on kinetic growth rate of the future liver remnant if applied following PVE or ALPPS. PLoS ONE |
| title | Negative impact of chemotherapy on kinetic growth rate of the future liver remnant if applied following PVE or ALPPS. |
| title_full | Negative impact of chemotherapy on kinetic growth rate of the future liver remnant if applied following PVE or ALPPS. |
| title_fullStr | Negative impact of chemotherapy on kinetic growth rate of the future liver remnant if applied following PVE or ALPPS. |
| title_full_unstemmed | Negative impact of chemotherapy on kinetic growth rate of the future liver remnant if applied following PVE or ALPPS. |
| title_short | Negative impact of chemotherapy on kinetic growth rate of the future liver remnant if applied following PVE or ALPPS. |
| title_sort | negative impact of chemotherapy on kinetic growth rate of the future liver remnant if applied following pve or alpps |
| url | https://doi.org/10.1371/journal.pone.0307937 |
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