Single centre experience with 45 cases of ALPPS for right trisectionectomy: long term oncological results.

Abstract

Background: Although ALPPS is a well known technique to induce a rapid hypertrophy of the future remnant liver volume (FLR), to little is still known about its oncological outcomes. Methods: We retrospectively analyzed our single center experience. Indication for ALPPS was a FLR to total liver volume ≤25% or remnant volume to body weight ratio ≤0,5. Volumetric parameters, postoperative complications according to the Dindo-Clavien classification, patient survival and tumour recurrence were analysed. Results: Between November 2010 and November 2016 we performed 45 right trisectionectomy as ALPPS for 26 primary liver tumors (6 phCCA, 11 iCCA, 2 Gallbladder carcinoma (GB-CA), 5 HCC and 2 Klatskin-mimicking IPN) and 19 metastatic tumors (18 CRLM, 1 breast cancer). Median age was 66 years (range=39-80). The feasibility was 100%. A R0 status was reached in 37 patients. Morbidity was 82,2% (major morbitiy 51,1%). 19 patients developed PHLF. The postoperative mortality rate was 13,3%. After a median follow-up of 23 months, 78% are still alive. The overall disease-free survival at 1 year was 62% (58% CRLM, 67% phCCA, 43% iCCA and 75% HCC). Twelve cases (9 CRLM, 2 phCCA, 5 iCCA and 1 HCC) developed tumour recurrences, and four of them (2 CRLM and 2 iCCA) died after recurrence. The 3-year OS was 92% for CRLM, 80% HCC, 67% phCCA, 50% iCCA. Conclusion: Avoiding postoperative mortality, ALPPS permit to achive excellent oncological outcomes, even though a high recurrence rate.