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

Introduction 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...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2013-05, Vol.17 (5), p.956-961
Main Authors: Li, Jun, Girotti, Paolo, Königsrainer, Ingmar, Ladurner, Ruth, Königsrainer, Alfred, Nadalin, Silvio
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Antibiotics
Bile Duct Neoplasms - surgery
Bile ducts
Bile Ducts, Intrahepatic
Cholangiocarcinoma
Cholangiocarcinoma - surgery
Female
Gastroenterology
Hepatectomy
Humans
Ligaments
Liver
Liver Failure - prevention & control
Liver Neoplasms - surgery
Male
Medicine
Medicine & Public Health
Middle Aged
Mortality
Original Article
Patient Safety
Postoperative Complications - prevention & control
Retrospective Studies
Sepsis - prevention & control
Surgery
Treatment Outcome
Tumors
Veins & arteries
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Summary:Introduction 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. Patients and Methods 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. Results 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. Conclusion 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.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-012-2132-y