Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Offers High Oncological Feasibility With Adequate Patient Safety A Prospective Study at a Single Center

作者：Alvarez Fernando A; Ardiles Victoria; de Santibanes Martin; Pekolj Juan; de Santibanes Eduardo

来源：Annals of Surgery, 2015, 261(4): 723-732.

DOI：10.1097/SLA.0000000000001046

• ALPPS
• hepatectomy
• liver failure
• hypertrophy
• scintigraphy

Objective: To determine the safety, feasibility, and efficacy of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in a single high-volume hepatobiliary center.
Background: The ALPPS approach allows achieving resectability of liver malignancies by a rapid and large future liver remnant (FLR) hypertrophy. However, this proposal has been associated with high morbidity and mortality rates.
Methods: This was a single-cohort, prospective, observational study [NCT 02164292]. Between June 2011 and April 2014, patients with liver malignancies considered unresectable due to an insufficient FLR who underwent ALPPS were included.
Results: Thirty patients were treated. Median age was 58.6 years (range = 35-81) and 19 patients were males (63%). In a median of 6 days (range = 4-67), the median FLR hypertrophy was 89.7% (range = 21-287). Twenty-nine patients completed the second stage (97% feasibility). Morbidity according to the Dindo-Clavien classification was 53% (grade >= IIIa 43% and grade >= IIIb 31%). The mortality rate was 6.6%. Total parenchymal transection was identified as an independent risk factor for complications (P = 0.049). There was not significant difference in terms of FLR hypertrophy between total or partial parenchymal transection (P = 0.45). Median hospital stay was 16 days (range = 11-62). The overall and disease-free survival at 1 year was 78% and 67% and at 2 years was 63% and 40%, respectively.
Conclusions: This prospective study on the largest reported single-center experience shows that ALPPS has acceptable morbidity and mortality, together with a high oncological feasibility and hypertrophic efficacy. Partial parenchymal transection seems to reduce morbidity without negatively impacting FLR hypertrophy.

• 出版日期2015-4