e694 E-AHPBA: Poster Abstracts
insufficiency which resolved without intervention within
30 postoperative days. Mean length of stay in hospital was
5 days for the other four patients.
Conclusions: ALPPS has become an established approach
to major liver resection and a feasible option for patients
previously deemed to have inoperable disease. Robotic
ALPPS affords better access to and control of intrahepatic
vasculature without the need to manipulate and mobilise
the liver, and is, therefore, a safer approach for patients with
multiple comorbidities, metabolic syndrome and cirrhosis,
sensitive to haemodynamic changes during surgery. It also
affords faster postoperative recovery and return to normal
activities and is, therefore, preferable to open surgery.
LIVER 0271
HEPATIC RESECTION FOR BREAST
CANCER LIVER METASTASES
N. Bacalbasa1, S. Dima2, I. Balescu3, V. Brasoveanu2 and
I. Popescu2
1
Carol Davila University of Medicine and Pharmacy;
2
Dan Setlacec Fundeni Clinical Institute Bucharest;
3
Ponderas Hospital Bucharest, Romania
Aims: To demonstrate the benefit of liver resection for
hepatic metastases from breast cancer and to identify the
most important predictors of survival.
Methods: Forty-three patients with breast cancer liver
metastases were submitted to liver resection for breast
cancer liver metastases in Fundeni Clinical Institute be-
tween 2002e2014.
Results: The mean age at the moment of liver resection was
52 years (range 31e79 years); 81,4% of cases received
preoperative chemotherapy or hormone-therapy before
liver resection. Four patients were diagnosed with syn-
chronous liver metastases while in the other 39 cases
metachronous lesions were found. Multiple liver lesions
were found in 19 cases while in 10 cases the largest tumor
dimension surpassed 5 cm. Major hepatic resections
(involving more than 3 segments) were performed in 14
cases while in the other 29 cases minor hepatic resections
(of less than 3 segments) were needed. The overall
morbidity rate was 16% while early postoperative mortality
rate was 0. In univariate analysis solitary versus multiple
liver metastases and tumoral dimension < 5 cm were sig-
nificant prognostic factors (33,2 months versus 25,3
months, p = 0,005 respectively 32,2 months versus 22,5
months p = 0,006); major hepatectomies were not associ-
ated with a poorer outcome when compared to minor re-
sections (p = 0,086).
Conclusions: Liver resection for breast cancer metastases
is safe and can provide survival benefit especially in pa-
tients with solitary, lesser than 5 cm lesions.
LIVER 0275
SPLENECTOMY AND SPLENIC ARTERY
LIGATION IN SWINE: NO IMPACT ON
PORTAL VEIN AND HEPATIC ARTERY
FLOW
B. Darnis, K. Mohkam, Z. Schmitt, S. Duperret, J. P. Vial,
C. Ducerf and J. Y. Mabrut
Croix-Rousse University Hospital, France
Aims: Splenectomy and splenic artery ligation may
prevent Small-For-Size Syndrome and post-hepatectomy
liver failure after liver transplant or major hepatectomy.
The main goals of such procedures is to modulate
the liver inflow. However there is no consensus about
their indication or the choice of the procedure. We
conducted an experimental study in swine to compare
the efficacy of these procedures on splanchnic
hemodynamics.
Methods: 12 pigs were used for the study. We performed
a simulation of splenectomy and a simulation of splenic
artery ligation on each of them (fig 1). The procedures
were performed either at the basal status (H0, n = 5), or
after 70% hepatectomy (H70, n = 4), or after 90% hepa-
tectomy (H90, n = 3). Portal vein flow (PVF) and hepatic
artery flow (HAF) were recorded with a transit-flow
recorder. Portal vein pressure and inverior vena cava
pressure were recorded with intravascular Millar captors,
in order to calculate the Hepatic Venous pressure Gradient
(HVPG).
Results: PVF increased after H70 and H90, HVPG
increased after H90. There was no impact of both
simulation of splenectomy and splenic artery ligation on
HAF, PVF or HVPG, in any group. A comparison of the
splenic vein flow-to-PVF in 8 pigs and 6 humans
showed that it was inferior in swine (9% vs 31%,
p < 0,001).
Conclusions: Splenectomy and splenic artery ligation
don’t modulate the liver inflow in swine. We assume that
the large bowel length and the very small splenic volume in
swine explain why these procedures don’t modulate the
liver inflow in this animal.
LIVER 0276
LIVER INFLOW ADAPTATION AFTER
MAJOR HEPATECTOMIES IS
EXPLAINED BY THE HEPATIC
COMPLIANCE
B. Darnis, K. Mohkam, Z. Schmitt, S. Duperret, J. P. Vial,
C. Ducerf and J. Y. Mabrut
Croix-Rousse University Hospital, France
Aims: Small-for-size syndrome is one of the main limiting
factors for the regeneration of the remnant liver after
extended hepatectomy. It is related to an imbalance be-
tween excessive portal venous inflow and insufficient liver
volume. Increase in portal vein flow (PVF) or in hepatic
veinous pressure gradient (HVPG) are predictors of SFSS
although no correlation between these values has been
established. We conducted an experimental study in swine
to assess the adaptation of the liver inflow after major and
subtotal hepatectomies.
Methods: 14 pigs underwent systemic and splanchnic he-
modynamics recording (PVF, HVPG , HAF : hepatic artery
flow) before and after 70% hepatectomy (H70 : n = 7) or
90% hepatectomy (H90 : n = 7). To evaluate the liver
compliance, we used Ohm’s law formula : PVR = HVPG/
PVF.
Results: PVF increased after H70 (273 vs 123 ml/min/100g
p = 0.016) and H90 (543 vs 124 ml/min/100g p = 0.031).
HVPG significantly increased only after H90 (10 vs
3,7mmHg p = 0.016). PVR was two times lower after H70
whereas it increased after H90. (fig1)
HPB 2016, 18 (S2), e685ee738