Abstract
BackgroundAssociating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and two stage hepatectomy with inter-stage portal vein embolization (TSH/PVE) are surgical maneuvers applied in patients with advanced malignancies considered unresectable by means of conventional liver surgery. The aim of this report is to compare the oncologic outcome and technical feasibility of ALPPS and TSH/PVE in the scenario of colorectal liver metastases (CRLM).MethodsAll consecutive patients who underwent either ALPPS or TSH/PVE for CRLM between 2011 and 2017 in one hepatobiliary center were analyzed and compared regarding perioperative and long-term oncologic outcome.ResultsA cohort of 58 patients who underwent ALPPS (n = 21) or TSH/PVE (n = 37) was analyzed. The median overall survival (OS) was 28 months and 34 months after ALPPS and TSH/PVE (p = 0.963), respectively. The median recurrence-free survival (RFS) was higher following ALPPS with 19 months than following TSH/PVE with 10 months, but marginally failed to achieve statistical significance (p = 0.05). There were no differences in morbidity and mortality after stages 1 and 2. Patients undergoing ALPPS due to insufficient hypertrophy after TSH/PVE (rescue-ALPPS) displayed similar oncologic outcome as patients treated by conventional ALPPS or TSH/PVE (p = 0.971).ConclusionsALPPS and TSH/PVE show excellent technical feasibility and comparable long-term oncologic outcome in CRLM. Rescue ALPPS appears to be a viable option for patients displaying insufficient hypertrophy after a TSH/PVE approach.
Highlights
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and two stage hepatectomy with inter-stage portal vein embolization (TSH/Portal vein embolization (PVE)) are surgical maneuvers applied in patients with advanced malignancies considered unresectable by means of conventional liver surgery
Patients Between 2011 and 2017, fifty-eight (n = 58) patients with colorectal liver metastases (CRLM) who were treated with ALPPS or Two-stage hepatectomy (TSH)/PVE at our hepatobiliary center were included in this study
Liver function determined by laboratory parameters and the quantitative liver function test Maximum liver function capacity (LiMAx) and computed tomography (CT) or magnetic resonance imaging (MRI)-based prediction of the future liver remnant (FLR) were incorporated in the operative risk assessment [16]
Summary
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and two stage hepatectomy with inter-stage portal vein embolization (TSH/PVE) are surgical maneuvers applied in patients with advanced malignancies considered unresectable by means of conventional liver surgery. Bednarsch et al World Journal of Surgical Oncology (2020) 18:140 embolization (TSH/PVE) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) have been added to the armamentarium of the hepatobiliary surgeon in recent years [4, 5]. Previous reports from the literature showed comparable survival rates to one-stage surgery as well as an acceptable perioperative mortality and displayed a significant proportion of patients who do not proceed to stage 2 surgery due to inter-stage tumor progression or insufficient growth of the future liver remnant (FLR) [7, 8]. While previous comparisons between TSH/PVE and ALPPS focussed on the perioperative comparability of the procedures, long-term follow-up has been addressed only by a few studies [10,11,12,13]
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