Is the extent of functional liver remnant increase truly "functional"? A single-institution case series of patients with Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS).

Abstract

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) aims to induce rapid hypertrophy of the future liver remnant (FLR) to reduce the risk of post-hepatectomy liver failure (PHLF). However, volumetric increase does not correspond to functional increase. This is a novel study which aims to compare the increase in standardized FLR (sFLR) vs. indocyanine green retention at 15 minutes (ICG-R15). This is a retrospective case series of patients who underwent ALPPS between May 2015 and January 2022. Primary outcomes were sFLR and ICG-R15. Secondary outcomes were incidence of PHLF, morbidity, recurrence, overall survival (OS) and disease-free survival (DFS). There were 10 patients with median age of 60.5 years (range 29-69). Most patients had adenocarcinoma secondary to colorectal origin (80%). There were 7 patients who received neoadjuvant chemotherapy [median 6 cycles (range 5-9)]. Median size of the primary tumour was 5.0 cm (range 2.0-7.0 cm). There was a significant increase in median ICG-R15 after stage 1 ALPPS (8.8% vs. 10.2%, p = 0.024) and increase in median sFLR after stage 1 ALPPS (34.4% vs. 53.0%, p = 0.012). Linear regression showed no significant correlation between sFLR increase and ICG-R15 (B = 0.26, 95% CI: -0.82, 1.34, p = 0.565). One patient had PHLF. Median time to local recurrence and metastatic recurrence was 14.4 months (range 6.9-21.9) and 7.5 months (range 6.9-17.3) respectively. OS and DFS were 50% and 40% respectively. No significant relationship was observed between ICG-R15 and sFLR. Volume increase may overestimate the functional increase following ALPPS. Larger studies are needed to validate our findings.