Laparoscopic Microwave Ablation and Portal Vein Occlusion for Staged Hepatectomy (LAPS)

Abstract

Background: Laparoscopic Microwave Ablation and Portal Vein Occlusion for Staged Hepatectomy (LAPS) is a new surgical technique based on ALPPS principle. Methods: Ten patients with primary or secondary malignant liver limited unresectable disease (median follow-up: 17 months - range= 1-33). Preoperative FLR/BW ratio < 0.8% was considered insufficient for resection in patients with cholestasis or chemotherapy-induced injury. Results: FLR hypertrophy of 288 cc (range 194-407) and 71.2% (range 43 to 132%) was evidenced with a median daily volume increase of 30.29 cc/day (range = 16.27 - 43.29). All patients completed Step2, on average 15.5 days after Step1 (range= 13-21). No ICU stay was required after Step1. R0 resection was achieved in 7/10 patients 70%). Post-operative morbidity revealed 19 events in 8 patients (80% with at least 1 complication – only 1 grade IIIb and no biliary complicantions). The morbidity rate after Step1 seems minimized (40% of patients, 6 events in 4 different patients - 32% of the total events, grade from I to IIIa), compared to Step2 (70% of patients; 13 events in 7 patients - 68% of events). The OS at 12 months was 88% with a mortality rate of 12% (one death for liver progression), with a median survival of 17 months (range= 1-33); no 90-days mortality was evidenced. Conclusion: LAPS technique was effective and relatively safe in preoperatively unresectable patients, proposing an inversion of the classical “ALPPS paradigm” with Step1 surgery minimization.