title: 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.
abstract: 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 [NCT02164292]. 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.
authors.affiliation: General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Alvarez
authors.forename: Victoria
authors.initials: V
authors.lastname: Ardiles
authors.forename: Martin
authors.initials: M
authors.lastname: de Santibañes
authors.forename: Juan
authors.initials: J
authors.lastname: Pekolj
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006529:Hepatomegaly / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008026:Ligation / Q000379:methods*; D008099:Liver / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000473:pathology; D009929:Organ Size; D061214:Patient Safety; D011169:Portal Vein / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures