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Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure
Published on: August 14, 2017
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Should ALPPS be Used for Liver Resection in Intermediate-Stage HCC?
J G D'Haese1, J Neumann2, M Weniger1
1Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Munich, Germany.
Annals of Surgical Oncology
|December 10, 2015
Summary
Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) induces liver hypertrophy in hepatocellular carcinoma (HCC) patients. However, the high perioperative mortality rate makes ALPPS prohibitive for most HCC patients.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Liver transplantation
Background:
- Extended liver resections for hepatocellular carcinoma (HCC) are challenging due to liver damage.
- Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) is a novel technique for inducing liver hypertrophy.
- Limited data exists on ALPPS outcomes in HCC patients.
Purpose of the Study:
- To investigate the outcomes of ALPPS in patients with HCC.
- To compare ALPPS outcomes between HCC and colorectal liver metastases (CRLM) patients.
- To identify factors influencing survival after ALPPS for HCC.
Main Methods:
- Retrospective analysis of patients from the international ALPPS Registry (2010-2015).
- Comparison of liver remnant hypertrophy, perioperative morbidity/mortality, and survival between HCC and CRLM groups.
- Multivariate analysis to identify predictors of survival.
Main Results:
- 35 HCC patients and 225 CRLM patients were analyzed.
- HCC patients showed significant hypertrophy (47%), but lower than CRLM patients (76%).
- 90-day mortality was significantly higher in HCC patients (31%) compared to CRLM patients (7%).
- Older age (>61 years) was associated with reduced overall survival in HCC patients.
Conclusions:
- ALPPS induces hypertrophy in HCC patients, enabling resection of intermediate-stage disease.
- The high perioperative mortality (31%) makes ALPPS generally prohibitive for HCC.
- ALPPS for HCC should be reserved for highly selected, younger patients with low-grade fibrosis.
