ALPPS for primary and secondary liver tumors.
BACKGROUND
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.
Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy. Electronic address: gvennarecci@scamilloforlanini.rm.it.
Giovanni
G
Vennarecci
Division of Hepatobiliary Surgery, Regina Elena Cancer Institute, Rome, Lazio, Italy.
Gian Luca
GL
Grazi
Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy.
Isabella
I
Sperduti
Division of Radiology, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
Elisa
E
Busi Rizzi
Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy.
Emanuele
E
Felli
Intensive Care Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
Mario
M
Antonini
Hepatology and Infectious Diseases Unit, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
Giampiero
G
D'Offizi
Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Lazio, Italy.
Giuseppe Maria
GM
Ettorre
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006984:Hypertrophy; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008099:Liver / Q000098:blood supply / Q000473:pathology; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018579:Patient Selection; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods
ALPPS; Cirrhosis; HCC; Liver resection; Portal vein embolization; Two stage hepatectomy