TY - JOUR
T1 - ALPPS for primary and secondary liver tumors
AU - Vennarecci, Giovanni
AU - Grazi, Gian Luca
AU - Sperduti, Isabella
AU - Busi Rizzi, Elisa
AU - Felli, Emanuele
AU - Antonini, Mario
AU - D'Offizi, Giampiero
AU - Ettorre, Giuseppe Maria
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Introduction: To report our experience on associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with liver tumors. Methods: ALPPS is a surgical technique that allows hepatic resection after rapid liver hypertrophy. Results: Thirteen operations were performed: 8 for hepatocellular carcinoma (HCC) with liver cirrhosis (LC) and 5 for colorectal liver metastases (CRLM, n = 3) and cholangiocarcinoma (CC, n = 2) in normal livers (NL). Of the 11 men (85%), the median age was 60 years (range 36-74). Six (75%) HCC patients had BCLC stage C and 2 (25%) had BCLC stage B disease. The median % future liver remnant (FLR) volume increase was 71.7% in patients with LC and 64.8% in NL (p = 0.44). Twelve patients achieved a sufficient FLR growth after the first stage (92.3% efficacy). Four right trisectorectomies and 9 right hepatectomies were performed. All patients completed the second stage (100% feasibility). R0 resection was achieved in all cases. The 90-day mortality rate was 23.1% (12.5% for HCC patients with LC vs 40% for CRLM and CC patients with NL, p = 0.13). After the first stage the overall morbidity rates were 62.5% and 80% (p = 0.61), whereas after the second stage they were 87.5% and 80% in patients with LC and NL respectively (p = 0.99). At a median follow-up of 15 months (range 1-27), the median DFS was 9 months (CI95% 6-12), and the 1yr-DFS was 42%. The median survival was 25 months (CI95% 10-40), and the 1-yr overall survival was 74%. Conclusions: ALPPS induced a considerable and comparable FLR growth in HCC patients with liver cirrhosis and patients with CRLM and CC with normal liver parenchyma. HCC patients who underwent ALPPS had a high rate of macrovascular tumor involvement. A high rate of R0 resection is expected in properly selected patients.
AB - Introduction: To report our experience on associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with liver tumors. Methods: ALPPS is a surgical technique that allows hepatic resection after rapid liver hypertrophy. Results: Thirteen operations were performed: 8 for hepatocellular carcinoma (HCC) with liver cirrhosis (LC) and 5 for colorectal liver metastases (CRLM, n = 3) and cholangiocarcinoma (CC, n = 2) in normal livers (NL). Of the 11 men (85%), the median age was 60 years (range 36-74). Six (75%) HCC patients had BCLC stage C and 2 (25%) had BCLC stage B disease. The median % future liver remnant (FLR) volume increase was 71.7% in patients with LC and 64.8% in NL (p = 0.44). Twelve patients achieved a sufficient FLR growth after the first stage (92.3% efficacy). Four right trisectorectomies and 9 right hepatectomies were performed. All patients completed the second stage (100% feasibility). R0 resection was achieved in all cases. The 90-day mortality rate was 23.1% (12.5% for HCC patients with LC vs 40% for CRLM and CC patients with NL, p = 0.13). After the first stage the overall morbidity rates were 62.5% and 80% (p = 0.61), whereas after the second stage they were 87.5% and 80% in patients with LC and NL respectively (p = 0.99). At a median follow-up of 15 months (range 1-27), the median DFS was 9 months (CI95% 6-12), and the 1yr-DFS was 42%. The median survival was 25 months (CI95% 10-40), and the 1-yr overall survival was 74%. Conclusions: ALPPS induced a considerable and comparable FLR growth in HCC patients with liver cirrhosis and patients with CRLM and CC with normal liver parenchyma. HCC patients who underwent ALPPS had a high rate of macrovascular tumor involvement. A high rate of R0 resection is expected in properly selected patients.
KW - ALPPS
KW - Cirrhosis
KW - HCC
KW - Liver resection
KW - Portal vein embolization
KW - Two stage hepatectomy
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U2 - 10.1016/j.ijsu.2016.04.031
DO - 10.1016/j.ijsu.2016.04.031
M3 - Article
AN - SCOPUS:84964506103
VL - 30
SP - 38
EP - 44
JO - International Journal of Surgery
JF - International Journal of Surgery
SN - 1743-9191
ER -