The ALPPS procedure: hepatocellular carcinoma as a main indication. An Italian single-center experience View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2018-09-25

AUTHORS

Giovanni Vennarecci, Daniele Ferraro, Antonella Tudisco, Giovanni Battista Levi Sandri, Nicola Guglielmo, Giammauro Berardi, Isabella Sperduti, Giuseppe Maria Ettorre

ABSTRACT

The ALPPS is a technique that allows achieving hepatic resection by a rapid future liver remnant hypertrophy. The aim of this study was to report the experience of an Italian center with ALPPS in patients with liver tumors. A retrospective analysis of patients undergoing ALPPS between 2012 and 2017 was performed. Patients’ characteristics and disease presentation, increase in future liver remnant (FLR) as well as intraoperative and postoperative short- and long-term outcomes were evaluated. A total of 24 patients underwent the ALPPS procedure: 17 procedures for hepatocarcinoma (HCC), 5 for colorectal liver metastases (CRLM), 1 for cholangiocarcinoma (CC) and 1 for Merkel Cell Carcinoma liver metastasis (MCCLM). Macrovascular invasion (MVI) was recorded in 10 (41.6%) patients: 8 (33.3%) patients with HCC had invasion of portal vein (5), middle hepatic vein (2) and inferior vena cava (1). One patient with CRLM had involvement of middle hepatic vein and one patient with CC had involvement of right portal vein and middle hepatic vein. A p-ALPPS in 14 cases (58.3%), 10 t-ALPPS (41.6%) and hanging maneuver in 19 patients (80%) were performed. Median postoperative stay was 26 days (range 16–68 days). 90-day mortality was 8.3% (two patients, one with CC and one with HCC), 90-day mortality for HCC was 5.8%. After stage 1, we counted 15 complications all of grade I; after stage 2 the number of complications was increased to 37:33 were of grade I and 4 were of grade IV. R0 resection was achieved in all patients with 100% oncology feasibility. After a median follow-up of 10 months (range 2–54), disease recurrence has been recorded in 6 patients with HCC and in 2 with CRLM. Eleven patients died, nine affected by HCC, one by CRLM, and one by CC. 2-years OS and disease-free survival (DFS) for the entire group were 47.3% and 47.5%, respectively. Concerning patients operated on for HCC, the 2-years OS and DFS were 38.5% and 60%, respectively. The ALPPS procedure is an interesting approach for large primary or secondary liver tumor with small FLR above all for large HCC associated with MVI, with acceptable OS and DFS. More... »

PAGES

67-75

References to SciGraph publications

  • 2014-12-02. Systematic Review and Meta-Analysis of Feasibility, Safety, and Efficacy of a Novel Procedure: Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in ANNALS OF SURGICAL ONCOLOGY
  • 2014-04-19. ALPPS Offers a Better Chance of Complete Resection in Patients with Primarily Unresectable Liver Tumors Compared with Conventional-Staged Hepatectomies: Results of a Multicenter Analysis in WORLD JOURNAL OF SURGERY
  • 2012-11-27. Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS): Tips and Tricks in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2015-12-08. Should ALPPS be Used for Liver Resection in Intermediate-Stage HCC? in ANNALS OF SURGICAL ONCOLOGY
  • 2013-12-11. ALPPS for Patients with Colorectal Liver Metastases: Effective Liver Hypertrophy, but Early Tumor Recurrence in WORLD JOURNAL OF SURGERY
  • 2017-08-09. Contribution of hepatobiliary scintigraphy in assessing ALPPS most suited timing in UPDATES IN SURGERY
  • 2012-09-21. Using ALPPS to Induce Rapid Liver Hypertrophy in a Patient with Hepatic Fibrosis and Portal Vein Thrombosis in JOURNAL OF GASTROINTESTINAL SURGERY
  • 2016-10-20. A literature review of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): so far, so good in UPDATES IN SURGERY
  • 2013-10-22. The ALPPS Procedure: A Surgical Option for Hepatocellular Carcinoma with Major Vascular Invasion in WORLD JOURNAL OF SURGERY
  • 2015-01-07. Strategies to Increase the Resectability of Patients with Colorectal Liver Metastases: A Multi-center Case-Match Analysis of ALPPS and Conventional Two-Stage Hepatectomy in ANNALS OF SURGICAL ONCOLOGY
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s13304-018-0596-3

    DOI

    http://dx.doi.org/10.1007/s13304-018-0596-3

    DIMENSIONS

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    PUBMED

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    38 schema:description The ALPPS is a technique that allows achieving hepatic resection by a rapid future liver remnant hypertrophy. The aim of this study was to report the experience of an Italian center with ALPPS in patients with liver tumors. A retrospective analysis of patients undergoing ALPPS between 2012 and 2017 was performed. Patients’ characteristics and disease presentation, increase in future liver remnant (FLR) as well as intraoperative and postoperative short- and long-term outcomes were evaluated. A total of 24 patients underwent the ALPPS procedure: 17 procedures for hepatocarcinoma (HCC), 5 for colorectal liver metastases (CRLM), 1 for cholangiocarcinoma (CC) and 1 for Merkel Cell Carcinoma liver metastasis (MCCLM). Macrovascular invasion (MVI) was recorded in 10 (41.6%) patients: 8 (33.3%) patients with HCC had invasion of portal vein (5), middle hepatic vein (2) and inferior vena cava (1). One patient with CRLM had involvement of middle hepatic vein and one patient with CC had involvement of right portal vein and middle hepatic vein. A p-ALPPS in 14 cases (58.3%), 10 t-ALPPS (41.6%) and hanging maneuver in 19 patients (80%) were performed. Median postoperative stay was 26 days (range 16–68 days). 90-day mortality was 8.3% (two patients, one with CC and one with HCC), 90-day mortality for HCC was 5.8%. After stage 1, we counted 15 complications all of grade I; after stage 2 the number of complications was increased to 37:33 were of grade I and 4 were of grade IV. R0 resection was achieved in all patients with 100% oncology feasibility. After a median follow-up of 10 months (range 2–54), disease recurrence has been recorded in 6 patients with HCC and in 2 with CRLM. Eleven patients died, nine affected by HCC, one by CRLM, and one by CC. 2-years OS and disease-free survival (DFS) for the entire group were 47.3% and 47.5%, respectively. Concerning patients operated on for HCC, the 2-years OS and DFS were 38.5% and 60%, respectively. The ALPPS procedure is an interesting approach for large primary or secondary liver tumor with small FLR above all for large HCC associated with MVI, with acceptable OS and DFS.
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