RALPP versus PVE for induction of liver hypertrophy - v1
Research type
Research Study
Full title
REBIRTH: Liver Regeneration: a single-centre, prospective, randomised controlled trial comparing radiofrequency assisted liver partition with portal vein ligation (RALPP) with portal vein embolization (PVE) for preoperative induction of liver hypertrophy in patients with insufficient future liver remnant volume for major liver resection.
IRAS ID
148741
Contact name
Long R Jiao
Contact email
Sponsor organisation
Joint Research Compliance Office, Imperial College London and Imperial College Healthcare NHS Trust
Research summary
Liver resection remains the gold standard treatment for patients with liver tumours providing them the only chance for long-term survival. In up to 45% of cases that are amenable to surgical resection, an extended hepatectomy (removal of part of the liver) is usually necessary to achieve a clear resection margin. However, there must be enough liver left behind to meet the demands of the body. Indeed, liver failure due to insufficient remnant liver volume is still the principal cause of postoperative death following a major liver resection.
The liver receives its main blood supply from two vessels (the portal vein and the hepatic artery). In order to decrease the complications and improve the safety of extensive liver surgery in patients with insufficient future liver remnant volume (FLRV), pre-operative embolization (i.e. blockage) of part of the portal vein can be undertaken. This has the effect of inducing growth of the liver on the unaffected side. Thus, when the resection is carried out, an increased FLRV (of around 30%) reduces post-operative liver failure. An alternative technique is to perform surgical ligation of the portal vein along with splitting of the liver. The diseased portion of liver is left in the body for 7-10 days while the healthy side is induced to grow. During this time, the diseased portion continues to support the body’s requirement for liver function and reduces the risk of liver failure. FLRV has been shown to increase by around 74% with this technique. However, there are more postoperative complications with the alternative technique such as bile leaks. The aim of this study is to test a new way of splitting the liver so that the increased FLRV can be achieved without the increased complication rate.
REC name
London - Bloomsbury Research Ethics Committee
REC reference
14/LO/1123
Date of REC Opinion
21 Jul 2014
REC opinion
Further Information Favourable Opinion