Abstract
The ALPPS (Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy) method was presented to the expert public with the intention of providing a chance to patients with metastatic or primary liver cancer and a lack of residual parenchyma excluding resection therapy which is considered to be the only curative treatment. This method has been regarded as controversial due to its high mortality and morbidity on the one hand and high resection success rate on the second hand. The article presents the initial experience from one workplace. Materials and Methods: From August 2013 to June 2014 eight patients were selected for ALPPS method of hepatic resection at the Surgery of the University Hospital Ostrava Czech republic. For all patients the initial FLR (future liver remnant) volume was less than 25% and they have exhausted other treatment options for the disease. Results: The group consisted of two men and six women, aged 40 to 70. Four patients had CRC (colorectal cancer) liver metastases and two patients were diagnosed with gallbladder cancer metastatic to the liver. The first female patient suffered from hilar cholangiocarcinoma and the last female patient had leiomyosarcoma. Altogether six patients were subject to both phases of the therapy (75% of cases). From the entire patient group one female patient died after the first phase due to haemorrhagic shock, and one was assessed by the multidisciplinary team as unsustainable for the second phase. Remaining all six patients who underwent both phases of surgery had R0 resection but three of them had severe liver failure and they ended fatally. Conclusion: ALPPS is a new method for inducing rapid hypertrophy of the liver parenchyma based on the ligation the portal vein branch and in-situ splitting. However this therapy is still burdened by a relatively high rate of morbidity and mortality which are directly related to the tumour’s histological character to the age of the patient and to the functional state of their hepatic parenchyma
Highlights
Hepatic resection remains the only hope for cure in patients with extensive hepatic metastases or with a large primary liver tumour
From August 2013 to June 2014, eight patients were selected for the ALPPS procedure of hepatic resection at the Surgery of the University Hospital Ostrava
The selection criteria for ALPPS procedure was based on the preoperative planning by a triphasic Computed Tomography (CT) with the volumetric assessment of the remnant liver volume (FLR-future liver remnant-less than 25%)
Summary
Hepatic resection remains the only hope for cure in patients with extensive hepatic metastases or with a large primary liver tumour. ALPPS (Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy) [1,2] is an innovative modification to the traditional two stage hepatectomy combining a hepatic parenchymal transection with portal vein ligation. This the first stage of procedure results in accelerated liver hypertrophy and enabling completion hepatectomy (stage 2) within a short period usually only one to two weeks. Despite these great advantages, ALPPS has been seriously challenged by criticisms due to reported high morbidity and mortality. Even experienced centres have reported high mortality rates up to 20% [3,4,5,6,7]
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