Indications & Techniques to Increase the Future Liver Remnant in Children Undergoing Hepatectomies

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Evidence on Indications and Techniques to Increase the Future Liver Remnant in Children Undergoing Extended Hepatectomy: A Systematic Review and Meta-Analysis of Individual Patient Data

June 1, 2022

HEIDELBERG, GERMANY – On May 30, 2022, Liver Surgery Research’s new research, “Evidence on Indications and Techniques to Increase the Future Liver Remnant in Children Undergoing Extended Hepatectomy: A Systematic Review and Meta-Analysis of Individual Patient Data,” authored by Juri Fuchs, Anastasia Murtha-Lemekhova, Lucas Rabaux-Eygasier, Markus Kessler, Fabian Ruping, Patrick Günther, and Katrin Hoffmann was published. This manuscript was published by the peer reviewed, open access journal Frontiers in Pediatrics, which has an impact factor of 3.418.

Background: Techniques to increase the future liver remnant (FLR) have fundamentally changed the indications and criteria of resectability in adult liver surgery. In pediatric patients however, these procedures have rarely been applied and the potential benefit or harm as well as suited indications are unclear.

Methods: A systematic literature search of MEDLINE, Web of Science, and CENTRAL was conducted. Based on a PRISMA-compliant, predefined methodology, all studies reporting pediatric patients (< 18y) undergoing liver resection with either associating liver partition and portal vein ligation for stages hepatectomy (ALPPS) or preoperative portal vein embolization or ligation (PVE/PVL) were included. Baseline data, periinterventional morbidity, increase of FLR and outcomes were analyzed.

Results: 15 studies reporting on 21 pediatric patients with a mean age of 4 years and 7 months (range 1.8 months – 17 years) were included. 12 ALPPS procedures, 8 PVE and 1 PVL were performed. The applied criteria for performing ALPPS or PVE were heterogenous and thresholds for minimally acceptable FLR varied. Mean FLR [% of total liver volume] before the intervention was 23.6% (range 15.0 – 39.3%) in the ALPPS group and 31.4% (range 21.5 – 56.0%) in the PVE group. Mean increase of FLR before stage 2 resection was 69.4% (range 19.0 – 103.8%) for ALPPS and 62.8% (range 25.0 – 108.0%) after PVE. No postoperative death occurred, one early intrahepatic recurrence after an ALPPS procedure was reported. Overall postoperative morbidity was 23.8%.

Conclusion: Validated criteria for minimal FLR in pediatric liver resection are lacking and so are clear indications for ALPPS or PVE. In special cases, ALPPS and PVE can be valuable techniques to achieve complete resection of pediatric liver tumors. However, more data are needed, and future studies should focus on a definition and validation of posthepatectomy liver failure as well as the minimally needed FLR in pediatric patients undergoing extended hepatectomy. To learn more about this study, visit https://doi.org/10.3389/fped.2022.915642.

About Liver Surgery Research

Liver Surgery Research (LSR) is a medical research group, located at Heidelberg University in Heidelberg – Germany. LSR specializes in research investigating liver regeneration after hepatectomy (liver resection) and post-hepatectomy liver failure, HCC development and treatment (especially in the context of MAFLD [metabolically associated fatty liver disease]), and rare liver lesions and diseases. LSR is the founder and leader of the RELIVE (RarE LIVEr) Initiative; a multidisciplinary project to establish evidence-based therapies for rare liver diseases. LSR is currently working on over 20 research projects and has over 100 peer reviewed published authorships. To learn more about Liver Surgery Research, visit www.liversurgeryresearch.com.

Contact:

Nicholas Murtha

Communications Manager

Liver Surgery Research at Heidelberg University

liversurgeryresearch@protonmail.com

nicholas.murtha@protonmail.com

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Reference:

Juri Fuchs, Anastasia Murtha-Lemekhova, Lucas Rabaux-Eygasier, Markus Kessler, Fabian Ruping, Patrick Günther, and Katrin Hoffmann. 2022. " Evidence on Indications and Techniques to Increase the Future Liver Remnant in Children Undergoing Extended Hepatectomy: A Systematic Review and Meta-Analysis of Individual Patient Data " Frontiers in Pediatrics, 10. DOI: 10.3389/fped.2022.915642, https://doi.org/10.3389/fped.2022.915642