Alpps for Primary and Secondary Liver Tumors

• Published in: International journal of surgery (London, England) Vol. 30; pp. 38 - 44
• Main Authors: Vennarecci, Giovanni, M.D, Grazi, Gian Luca, Sperduti, Isabella, Busi Rizzi, Elisa, Felli, Emanuele, Antonini, Mario, D’Offizi, Giampiero, Ettorre, Giuseppe Maria
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2016
• Subjects: Adult; Aged; ALPPS; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Cirrhosis; Colorectal Neoplasms - pathology; Female; HCC; Hepatectomy - adverse effects; Hepatectomy - methods; Humans; Hypertrophy; Ligation - adverse effects; Ligation - methods; Liver - blood supply; Liver - pathology; Liver Cirrhosis - surgery; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Liver resection; Male; Middle Aged; Morbidity; Neoplasm Invasiveness; Neoplasm Staging; Patient Selection; Portal Vein - pathology; Portal Vein - surgery; Portal vein embolization; Retrospective Studies; Surgery; Tomography, X-Ray Computed; Two stage hepatectomy; Vascular Surgical Procedures - methods; Two Stage Hepatectomy; Cirrhosis; HCC; Portal Vein Embolisation; Liver Resection; ALPPS; Two stage hepatectomy; Liver resection; Portal vein embolization
• ISSN: 1743-9191; 1743-9159
• DOI: 10.1016/j.ijsu.2016.04.031

Abstract Introduction To report our experience on associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with liver tumors. Methods ALPPS is a surgical technique that allows hepatic resection after rapid liver hypertrophy. Results Thirteen operations were performed: 8 for hepatocellular carcinoma (HCC) with liver cirrhosis (LC) and 5 for colorectal liver metastases (CRLM, n=3) and cholangiocarcinoma (CC, n=2) in normal livers (NL). Of the 11 men (85%), the median age was 60 years (range 36-74). Six (75%) HCC patients had BCLC stage C and 2 (25%) had BCLC stage B disease. The median % future liver remnant (FLR) volume increase was 71.7% in patients with LC and 64.8% in NL (p=0.44). Twelve patients achieved a sufficient FLR growth after the first stage (92.3% efficacy). Four right trisectorectomies and 9 right hepatectomies were performed. All patients completed the second stage (100% feasibility). R0 resection was achieved in all cases. The 90-day mortality rate was 23.1% (12.5% for HCC patients with LC vs 40% for CRLM and CC patients with NL, p=0.13). After the first stage the overall morbidity rates were 62.5% and 80% (p=0.61), whereas after the second stage they were 87.5% and 80% in patients with LC and NL respectively (p=0.99). At a median follow-up of 15 months (range 1-27), the median DFS was 9 months (CI95% 6-12), and the 1yr-DFS was 42%. The median survival was 25 months (CI95% 10-40), and the 1-yr overall survival was 74%. Conclusions ALPPS induced a considerable and comparable FLR growth in HCC patients with liver cirrhosis and patients with CRLM and CC with normal liver parenchyma. HCC patients who underwent ALPPS had a high rate of macrovascular tumor involvement. A high rate of R0 resection is expected in properly selected patients.