ALPPS in Right Trisectionectomy: a Safe Procedure to Avoid Postoperative Liver Failure?

作者：Li Jun; Girotti Paolo; Koenigsrainer Ingmar; Ladurner Ruth; Koenigsrainer Alfred; Nadalin Silvio^*

来源：Journal of Gastrointestinal Surgery, 2013, 17(5): 956-961.

DOI：10.1007/s11605-012-2132-y

• Hepatectomy
• Liver failure
• Two-stage liver resection
• Indication

To induce rapid hepatic hypertrophy and to reduce post-hepatectomy liver failure (PHLF), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients with a limited future liver remnant. The aim of this study was to further assess the perioperative risk of this procedure and its specific indications. %26lt;br%26gt;The study was performed between November 2010 and April 2012 for patients undergoing right trisectionectomy by the ALPPS approach. Liver volume, intra- and postoperative complications, including PHLF, and residual tumour status were compared for patients with different diagnoses. %26lt;br%26gt;The interval between two operations in nine patients undergoing ALPPS was 13 days (median). Sufficient hepatic hypertrophy was achieved with a volume gain of 87.2 % (median). All patients underwent right trisectionectomy without residual tumours. In contrast to six patients with uneventful intra- and postoperative course, bile leak, vancomycin-resistant enterococcus infection, PHLF and sepsis developed in two of three patients with hilar cholangiocarcinoma as the preoperative diagnosis. %26lt;br%26gt;ALPPS leads to sufficient hepatic hypertrophy within 2 weeks, avoiding PHLF in most patients. In patients with hilar cholangiocarcinoma, ALPPS should be applied with extreme caution due to high morbidity and mortality.

• 出版日期2013-5