Evolution of ALPPS:the simpler, safer and effective one---TELPP

Abstract

Background: Numerous modifications have been suggested for improvement of ALPPS. We suggest Terminal Branches Portal Vein Embolization (TBPVE) as a way to compart the liver. This method is termed Terminal branches portal vein Embolization Liver Partition Planned hepatectomy (TELPP). Methods: The procedure of TELPP was that in addition to PVE, embolization agent was infused to the terminal branches of portal vein of S5,S8 or S4. CT scan was taken one or two weeks later , and standard liver volume(SLV), FLR and FLR/SLV are calculated. Two weeks later, open or laparoscopic hepatectomy is performed. Results: Patients including hepatocellular carcinoma: n =8, intrahepatic cholangiocarcinoma: n = 1, hilarcholangiocarcinoma: n =1, colorectal liver metastasis: n =1. The volume of theFLR had increased from 382ml to 578ml, representing a median volume increase of 51% (range =32.5%-86.7%). Of the 11 patients with hepatectomy, right hemihepatectomy(n=2), extended right hemihepatectomy (n=5) ,right trisecmentectomy(n=2), extended left hemihepatectomy (n=1) and left trisecmentectomy(n=1). No patient died, and no serve perioperative morbidity occurred. Conclusion: The ALPPS and all modifications need two-stage operations with a high morbidity and mortality rate. It seems that TELPP is very promising. It has the merit of ALPPS as extraordinarily rapid increasement of FLR volume, yet the morbidity and mortality is much lowe, as only single surgical operation is required.