Hypertrophy and Liver Function in ALPPS: Correlation with Morbidity and Mortality

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Liver transplantation

Background:

• Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) aims to reduce posthepatectomy liver failure (PHLF) in extended hepatectomies.
• However, ALPPS is associated with higher morbidity and mortality rates compared to conventional methods.
• Limited data exist on PHLF incidence and functional assessment following ALPPS.

Purpose of the Study:

• To review published data on the incidence of PHLF after ALPPS.
• To assess liver function following ALPPS and its modifications.
• To identify strategies for avoiding PHLF in ALPPS procedures.

Main Methods:

• Systematic review of literature on ALPPS and liver failure.
• Literature search conducted in PubMed, with article evaluation, selection, and tabulation.
• Analysis of studies on PHLF incidence and functional assessment after ALPPS.

Main Results:

• 326 articles met selection criteria; PHLF criteria (ISGLS) were inconsistently applied.
• PHLF occurred in approximately 30% of patients after stage 2 of ALPPS.
• Hepatobiliary scintigraphy revealed a discrepancy between liver volume gain (100%) and functional gain (50%), with immature liver histology observed.

Conclusions:

• ALPPS is associated with high rates of PHLF, morbidity, and mortality.
• Discrepancy between volumetric and functional liver growth explains compromised liver function.
• Functional assessment is essential, and ALPPS should be performed with caution.