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World J Gastrointest Surg. Jul 27, 2012; 4(7): 163-165
Published online Jul 27, 2012. doi: 10.4240/wjgs.v4.i7.163
Is there new hope for patients with marginally resectable liver malignancies
Martin Loos, Helmut Friess
Martin Loos, Helmut Friess, Department of Surgery, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
Author contributions: Loos M and Friess H collected the material; Loos M drafted the article; Friess H critically revised the article; both authors approved the final version of the manuscript.
Correspondence to: Helmut Friess, MD, Professor, Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany. helmut.friess@tum.de
Telephone: +49-89-41402121 Fax: +49-89-41404870
Received: July 11, 2012
Revised: July 18, 2012
Accepted: July 20, 2012
Published online: July 27, 2012
Abstract

Advances in surgical technique and better perioperative management have significantly improved patient outcomes after liver surgery. Even major hepatectomy can be performed safely with low morbidity and mortality. Post-resection liver failure is among the most feared complications after extended hepatectomy. In order to increase the future liver remnant (FLR) and to expand the pool of candidates for surgical resection, Schnitzbauer et al recently presented a new 2-stage surgical approach which combines right portal vein ligation (rPVL) with in situ splitting (ISS) of the liver parenchyma. In comparison to other current strategies, such as interventional portal vein embolization, hypertrophy of the FLR was more pronounced (median volume increase = 74%; range: 21%-192%) and more rapid (after a median of 9 d; range: 5-28 d) after rPVL and ISS. In this commentary, we discuss the technical aspects and clinical impact of rPVL combined with ISS. Based on the reported data, this new 2-stage therapeutic approach represents a promising new strategy for patients with locally advanced liver disease, previously regarded as marginally resectable or even unresectable, potentially enabling curative resection. However, morbidity is significant and mortality not negligible.

Keywords: Right portal vein ligation; In situ splitting; Liver resection; Liver function; Liver malignancy