Laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Surgery (ALPPS), A Safer Operation Compared to Open: A Tertiary Asian Center Experience

Abstract

Introduction: Associating liver partition and portal vein ligation for staged hepatectomy surgery (ALPPS) has increasingly been recognised as a method to grow future liver remnant to increase the chance of resectability in liver tumours. However, it was burdened with the high incidence of morbidity and mortality, attracting the criticism that it is unsafe. We compare the outcomes between laparoscopic and open ALPPS at a tertiary Asian Institute. Methods: Patients who underwent ALPPS at the National University Hospital, Singapore from 2014 to 2020 were included and stratified to open and laparoscopic ALPPS group. Patient demographics and outcome data was collected. Primary outcomes include duration of operation, intra-operative blood loss, post-operative morbidity, FLR growth after stage 1 procedure, treatment failure, and pain score. Results were analysed using SPSS Ver 26.0. Results: Of the 25 patients, 9 (36%) underwent laparoscopic ALPPS. There was no significant difference in operation duration, blood loss, and FLR growth between the 2 groups. Patients with liver fibrosis had a lower FLR growth in both groups. Laparoscopic ALPPS patients had significantly lower post-operative morbidity compared to open ALPPS (22.5% vs 84.6%, p=0.025. Post-operative pain was significantly lower for laparoscopic ALPPS patients. Median LOS was substantially shorter for the laparoscopic ALPPS group (12 vs 23 days). Conclusion: This study has shown that laparoscopic ALPPS can be performed in a safe and feasible manner with comparable, if not better outcomes compared to open ALPPS. Laparoscopic ALPPS should be considered as an alternative to open ALPPS for experienced surgeons.