ALPPS in right trisectionectomy: a safe procedure to avoid postoperative liver failure?

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Liver Regeneration

Background:

• Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel approach for patients with limited future liver remnant.
• ALPPS aims to induce rapid hepatic hypertrophy and reduce post-hepatectomy liver failure (PHLF).

Purpose of the Study:

• To evaluate the perioperative risks associated with the ALPPS procedure.
• To identify specific indications and patient groups for ALPPS.

Main Methods:

• Retrospective analysis of patients undergoing right trisectionectomy via ALPPS between November 2010 and April 2012.
• Comparison of liver volume changes, complications (including PHLF), and tumor status across different diagnoses.

Main Results:

• A median interval of 13 days between surgeries resulted in 87.2% median liver volume gain.
• All patients achieved complete tumor resection without residual disease.
• While most patients had uneventful recovery, two of three with hilar cholangiocarcinoma developed complications including bile leak, infection, PHLF, and sepsis.

Conclusions:

• ALPPS effectively achieves substantial liver hypertrophy within two weeks, mitigating PHLF in the majority of patients.
• ALPPS should be used with extreme caution in patients diagnosed with hilar cholangiocarcinoma due to significantly higher morbidity and mortality rates.