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ALPPS Procedure for Extended Liver Resections: A Single Centre Experience and a Systematic Review

Authors :
Andrea Agostini
Roberto Montalti
Marco Vivarelli
Daniele Nicolini
Paolo Vincenzi
Federico Mocchegiani
Martina Coletta
Giammarco Fava
A. Vecchi
Marcello Tavio
Emad A. Ahmed
Andrea Giovagnoni
Vivarelli, Marco
Vincenzi, Paolo
Montalti, Roberto
Fava, Giammarco
Tavio, Marcello
Coletta, Martina
Vecchi, Andrea
Nicolini, Daniele
Agostini, Andrea
Ahmed, Emad Ali
Giovagnoni, Andrea
Mocchegiani, Federico
Source :
PLoS ONE, Vol 10, Iss 12, p e0144019 (2015), PLoS ONE
Publication Year :
2015
Publisher :
Public Library of Science (PLoS), 2015.

Abstract

AIM:To report a single-centre experience with the novel Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) technique and systematically review the related literature. METHODS:Since January 2013, patients with extended primary or secondary liver tumors whose future liver remnant (FLR) was considered too small to allow hepatic resection were prospectively assessed for the ALPPS procedure. A systematic literature search was performed using PubMed, Scopus and the Cochrane Library Central. RESULTS:Until July 2014 ALPPS was completed in 9 patients whose mean age was 60 ± 8 years. Indications for surgical resection were metastases from colorectal cancer in 3 cases, perihilar cholangiocarcinoma in 3 cases, intrahepatic cholangiocarcinoma in 2 cases and hepatocellular carcinoma without chronic liver disease in 1 case. The calculated FLR volume was 289 ± 122 mL (21.1 ± 5.5%) before ALPPS-1 and 528 ± 121 mL (32.2 ± 5.7%) before ALLPS-2 (p < 0.001). The increase in FLR between the two procedures was 96 ± 47% (range: 24-160%, p < 0.001). Additional interventions were performed in 4 cases: 3 patients underwent Roux-en-Y hepaticojejunostomy, and one case underwent wedge resection of a residual tumor in the FLR. The average time between the first and second step of the procedure was 10.8 ± 2.9 days. The average hospital stay was 24.1 ± 13.3 days. There was 1 postoperative death due to hepatic failure in the oldest patient of this series who had a perihilar cholangiocarcinoma and concomitant liver fibrosis; 11 complications occurred in 6 patients, 4 of whom had grade III or above disease. After a mean follow-up of 17.1 ± 8.5 months, the overall survival was 89% at 3-6 and 12 months. The recurrence-free survival was 100%, 87.5% and 75% at 3-6-12 months respectively. The literature search yielded 148 articles, of which 22 articles published between 2012 and 2015 were included in this systematic review. CONCLUSION:The ALPPS technique effectively increased the resectability of otherwise inoperable liver tumors. The postoperative morbidity in our series was high in accordance with the data from the systematic review. Age, liver fibrosis and presence of biliary stenting were predisposing factors for postoperative morbidity and mortality.

Details

Language :
English
ISSN :
19326203
Volume :
10
Issue :
12
Database :
OpenAIRE
Journal :
PLoS ONE
Accession number :
edsair.doi.dedup.....203c52df16b1c3af2b0b170324b0c820