ALPPS vs PVL two stage liver resections: matching surgical and oncological outcomes

Abstract

Background: The aim of this study was to compare the clinical changes associated with ALPPS and PVL and assess the oncological outcomes. Methods: Retrospective analysis of 30 patients with CRLM and HCC operated with TSH technique(ALPPS or PVL) at the abdominal oncology department P.HERZEN MORI. After analysis of the whole cohort, both groups were matched and analyzed. Results: Fifteen patients age 57±11.6 yr were operated by PVL techniques for 5±3 (2-10)metastases of which the largest was 58±27mm. ALPPS was initiated for 2.8±1.6metastases of which the largest was 64.6±18.8mm in 15 patients whose mean age was 59±6.3yr. One patient had salvage ALPPS after failed PVL. The time between 2 steps was 72.3±32.8days for PVL and 9.4±1.4days for ALPPS, FLR increased by 59.5±65.9% vs 95.1±53.6 resp. (p<0.001). The second stage of PVL was performed in 73.3% patients, ALPPS-2 in 86,7%. Major complication (Clavien ≥IIIb)rates were 0% vs. 9,1% in the PVL and ALPPS group, resp. There was 2 (15%) postop death after ALPPS-1 due to hepatic failure in the patients who had a HCC and liver cirrhosis. The overall survival of the ALPPS group was significantly lower than of the PVL(26,1mo vs. 44.0mo, p = 0.021), as well as disease-free survival (24,1mo vs.39,4mo, p=0.011). Conclusion: The ALPPS technique can be associated with a hypertrophic stimulus on the future liver remnant (FLR) stronger than other techniques–such as portal vein ligation at early terms. Meanwhile, ALPPS in patients with HCC associated with a high risk of fatal complications.