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Eur J Surg Oncol. 2015 May;41(5):674-82. doi: 10.1016/j.ejso.2015.01.004. Epub 2015 Jan 17.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): impact of the inter-stages course on morbi-mortality and implications for management.

Author information

1
Department of Digestive Surgery and Transplantation, CHU, Univ Nord de France, Lille, France. Electronic address: stephanie.truant@chru-lille.fr.
2
Department of Hepatobiliary Surgery and Liver Transplant, St Antoine Hospital, France.
3
Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
4
Department of Digestive Surgery, Amiens University Medical Centre, Amiens, France.
5
Department of Abdominal Surgery and Transplantation, Hospital Erasme, Brussels University, Belgium.
6
Department of Digestive and Hepatobiliary Surgery, AP-HP, Henri Mondor University Hospital, Créteil, France.
7
Department of General and Visceral Surgery, University Hospital of Poitiers, France.
8
Hepatobiliary Centre, Paul Brousse Hospital, AP-HP, Univ Paris-Sud, Villejuif, France.
9
Department of Digestive Surgery and Liver Transplantation, AP-HM, La Conception Hospital, Aix-Marseille University, France.
10
Department of Digestive Surgery and Transplantation, CHU, Univ Nord de France, Lille, France.

Abstract

BACKGROUND:

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was recently developed to induce rapid hypertrophy and reduce post-hepatectomy liver failure in patients with insufficient remnant liver volume (RLV). However, mortality rates >12% have been reported. This study aimed to analyze the perioperative course of ALPPS and to identify factors associated with morbi-mortality.

METHODS:

Between April 2011 and September 2013, 62 patients operated in 9 Franco-Belgian hepatobiliary centres underwent ALPPS for colorectal metastases (N = 50) or primary tumors, following chemotherapy (N = 50) and/or portal vein embolization (PVE; N = 9).

RESULTS:

Most patients had right (N = 31) or right extended hepatectomy (N = 25) (median RLV/body weight ratio of 0.54% [0.21-0.77%]). RLV increased by 48.6% [-15.3 to 192%] 7.8 ± 4.5 days after stage1, but the hypertrophy decelerated beyond 7 days. Stage2 was cancelled in 3 patients (4.8%) for insufficient hypertrophy, portal vein thrombosis or death and delayed to ≥9 days in 32 (54.2%). Overall, 25 patients (40.3%) had major complication(s) and 8 (12.9%) died. Fourteen patients (22.6%) had post-stage1 complication of whom 5 (35.7%) died after stage2. Factors associated with major morbi-mortality were obesity, post-stage1 biliary fistula or ascites, and infected and/or bilious peritoneal fluid at stage2. The latter was the only predictor of Clavien ≥3 by multivariate analysis (OR: 4.9; 95% CI: 1.227-19.97; p = 0.025). PVE did not impact the morbi-mortality rates but prevented major cytolysis that was associated with poor outcome.

CONCLUSIONS:

The inter-stages course was crucial in determining ALPPS outcome. The factors of high morbi-mortality rates associated with ALPPS are linked to the technique complexity.

KEYWORDS:

ALPPS; Liver regeneration; Morbi-mortality; Remnant liver; Two-stage hepatectomy

PMID:
25630689
DOI:
10.1016/j.ejso.2015.01.004
[Indexed for MEDLINE]

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