Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): Impact of the inter-stages course on morbi-mortality and implications for management. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Truant, S.; Scatton, O.; Dokmak, S.; Regimbeau, J.-M.; Lucidi, V.; Laurent, A.; Gauzolino, R.; Castro Benitez, C.; Pequignot, A.; Donckier, V.; Lim, C.; Blanleuil, M.-L.; Brustia, R.; Le Treut, Y.-P.; Soubrane, O.; Azoulay, D.; Farges, O.; Adam, R.; Pruvot, F.-R.; the e-HPBchir Study Group from the Association de Chirurgie Hépato-Biliaire et de Transplantation (ACHBT)
• Is Part Of: European journal of surgical oncology. Volume 41:Issue 5(2015:May)
• Page Start: 674
• Page End: 682
• Publication Date: 2015-05
• Subjects: Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2015.01.004
• Languages: English
• ISSNs: 0748-7983

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Abstract</title> <sec> <title id="sectitle0015">Background</title> <p id="abspara0010">Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was recently developed to induce rapid hypertrophy and reduce post-hepatectomy liver failure in patients with insufficient remnant liver volume (RLV). However, mortality rates >12% have been reported. This study aimed to analyze the perioperative course of ALPPS and to identify factors associated with morbi-mortality.</p> </sec> <sec> <title id="sectitle0020">Methods</title> <p id="abspara0015">Between April 2011 and September 2013, 62 patients operated in 9 Franco-Belgian hepatobiliary centres underwent ALPPS for colorectal metastases (N = 50) or primary tumors, following chemotherapy (N = 50) and/or portal vein embolization (PVE; N = 9).</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0020">Most patients had right (N = 31) or right extended hepatectomy (N = 25) (median RLV/body weight ratio of 0.54% [0.21–0.77%]). RLV increased by 48.6% [−15.3 to 192%] 7.8 ± 4.5 days after stage1, but the hypertrophy decelerated beyond 7 days. Stage2 was cancelled in 3 patients (4.8%) for insufficient hypertrophy, portal vein thrombosis or death and delayed to ≥9 days in 32 (54.2%). Overall, 25 patients (40.3%) had major complication(s) and 8 (12.9%) died. Fourteen patients (22.6%) had post-stage1 complication of whom 5 (35.7%) died after stage2. Factors associated with major morbi-mortality were obesity, post-stage1 biliary fistula or ascites, and infected and/or bilious peritoneal fluid at stage2. The latter was the only predictor of Clavien ≥3 by multivariate analysis (OR: 4.9; 95% CI: 1.227–19.97; p = 0.025). PVE did not impact the morbi-mortality rates but prevented major cytolysis that was associated with poor outcome.</p> </sec> <sec> <title id="sectitle0030">Conclusions</title> <p id="abspara0025">The inter-stages course was crucial in determining ALPPS outcome. The factors of high morbi-mortality rates associated with ALPPS are linked to the technique complexity.</p> </sec> </abstract>