Aim. To report a single-centre experience with the novel Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) technique. Methods. Patients with extended primary or secondary liver tumors whose future liver remnant (FLR) was considered too small to allow a standard hepatic resection were prospectively assessed for the ALPPS procedure. Results. From January 2013 until December 2018, 25 patients were considered for the ALPPS procedure at our institution. Five patients were judged intraoperatively not to be suitable for the surgical therapy and two patients underwent the first step of the ALPPS procedure but did not complete the second step. The ALPPS procedure was completed in 18 patients whose median age was 61.9 ± 6.5 years. Indications for surgical resection were metastases from colorectal cancer in 4 cases, perihilar cholangiocarcinoma in 4 cases, intrahepatic cholangiocarcinoma in 4 cases, hepatocellular carcinoma in 4 cases and gallbladder carcinoma in 2 cases. The calculated FLR volume was 302.5 ± 88.9 mL (22.6 ± 5.2% of the total liver volume) before ALPPS-1 and 514.4 ± 130.0 mL (31.9 ± 6.0%) before ALLPS-2 (p < 0.001). After a mean interval of 10.6 ± 2.6 days between the two procedures, the increase in FLR was 76.4 ± 39.6% (p < 0.001). Sixteen (88.9%) out of 18 patients required one or more additional interventions during the first surgical step; these consisted in 7 Roux-en-Y hepaticojejunostomy, 3 wedge resections of a residual tumor in the FLR and 10 cholecystectomies. The median hospital stay was 23 (IQR: 22-27.7) days. In-hospital mortality occurred in 3 (16.7%) patients for postoperative liver failure (2 cases) and multiple organ failure; 10 (55.5%) out of 18 patients experienced a grade III or above surgical complication according to Clavien-Dindo classification. After a median follow-up of 26.6 (IQR: 4.5-40.0) months, the 1- and 3-years overall survival rates were 69.4% and 47.6%, respectively. The 1- and 3-years recurrence-free survival rates were 70.7% and 53.0%, respectively. Conclusion. The ALPPS technique effectively increased the resectability of otherwise inoperable liver tumors, improving survival in these patients. The postoperative morbidity in our series was high in accordance with the data from the international ALPPS registry.
Advances in hepatobiliary surgery: The ancona’s experience with ALPPS procedure for extended liver resections / Mocchegiani, F.; Vivarelli, M.. - (2020), pp. 265-283. [10.1007/978-3-030-33832-9_18]