Minimally invasive first stage with same-admission right portal vein embolization preparing for two-stage hepatectomy: safety and efficacy

Background: Two-stage hepatectomy (TSH) expands local treatment options in patients with extensive bilobar liver tumors. The success of TSH depends on rapid recovery after first-stage treatment, effective hypertrophy induction, and precise functional liver remnant function assessment to minimize the risk of posthepatectomy liver failure (PHLF). This study aimed to assess the safety and efficacy of minimally invasive left-sided local liver treatment with or without partial associated liver partition and portal vein ligation for staged hepatectomy (pALPPS) or pALPPS alone combined with same-admission right portal vein embolization (PVE) and routine assessment of liver function using hepatobiliary scintigraphy (HEBIS). Methods: This retrospective cohort study included all patients who underwent minimally invasive left-sided liver resection, ablation, or pALPPS alone followed by same-admission PVE as the first stage of TSH at the Amsterdam University Medical Center between 2015 and 2022. Perioperative outcomes were assessed. Results: In 20 patients, minimally invasive first-stage left liver resection and/or ablation or pALPPS alone was performed for colorectal liver metastases (n = 17), hepatocellular carcinoma (n = 2), and cholangiocarcinoma (n = 1), with pALPPS in 11 patients. Subsequently, 19 patients underwent same-admission PVE, with a median time to PVE of 2 days (IQR, 1–4). Of note, 2 patients (10%) experienced Clavien-Dindo grade ≥ IIIa complications after the first stage treatment. The median hospital stay was 5 days (IQR, 3–4). Ultimately, 14 patients (70%) underwent second-stage (extended) right hemihepatectomy with no grade B/C PHLF or 90-day mortality. Conclusion: Minimally invasive first-stage resection combined with same-admission PVE and routine HEBIS is safe and feasible and yields excellent outcomes, including 70% second-stage hepatectomies and no 90-day mortality. Larger multicenter studies should be conducted to confirm the findings.