The Journal of surgical research · 2026
Liver Remnant Hypertrophy: A Model-Based Evaluation of Associated Liver Partition and Portal Vein Ligation for Staged Hepatectomy Versus Liver Venous Deprivation.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Smith Savannah R, Cheney Sarah M, Sarmiento Juan M
Аннотация
INTRODUCTION: Patients undergoing major hepatectomy require a future liver remnant (FLR) of at least 30%. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) are hypertrophy techniques for inadequate FLR. We sought to evaluate the cost-effectiveness of these techniques in patients with FLR <30%.
METHODS: Via Markov modeling, we assessed clinical and economic outcomes of ALPPS and LVD. Quality-adjusted life years (QALYs), costs (2022 USD), and incremental cost-effectiveness ratios (ICERs) were assessed. We conducted sensitivity analyses to evaluate the robustness of our model to changes in input parameters.
RESULTS: LVD resulted in 0.60 QALYs and $42,500; ALPPS accumulated 0.58 QALYs and $126,500. LVD was therefore preferred in the base case. Though LVD reduced costs, fewer simulated patients achieved hepatectomy due to disease progression while awaiting hypertrophy. If time to adequate hypertrophy for LVD was <30 d, LVD substantially increased QALYs compared to ALPPS.
CONCLUSIONS: LVD and ALPPS are both acceptable techniques. LVD is preferred from a cost-effectiveness standpoint; however, if time to adequate hypertrophy were reduced or patient selection optimized to ensure at least 90% of LVD patients achieve hepatectomy, LVD would substantially improve QALYs while still saving costs compared to ALPPS.
METHODS: Via Markov modeling, we assessed clinical and economic outcomes of ALPPS and LVD. Quality-adjusted life years (QALYs), costs (2022 USD), and incremental cost-effectiveness ratios (ICERs) were assessed. We conducted sensitivity analyses to evaluate the robustness of our model to changes in input parameters.
RESULTS: LVD resulted in 0.60 QALYs and $42,500; ALPPS accumulated 0.58 QALYs and $126,500. LVD was therefore preferred in the base case. Though LVD reduced costs, fewer simulated patients achieved hepatectomy due to disease progression while awaiting hypertrophy. If time to adequate hypertrophy for LVD was <30 d, LVD substantially increased QALYs compared to ALPPS.
CONCLUSIONS: LVD and ALPPS are both acceptable techniques. LVD is preferred from a cost-effectiveness standpoint; however, if time to adequate hypertrophy were reduced or patient selection optimized to ensure at least 90% of LVD patients achieve hepatectomy, LVD would substantially improve QALYs while still saving costs compared to ALPPS.