Importance of primary indication and liver function between stages: Results of a multicenter Italian audit of ALPPS 2012-2014

Matteo Serenari, Matteo Zanello, Erik Schadde, Elena Toschi, Francesca Ratti, Enrico Gringeri, Michele Masetti, Umberto Cillo, Luca Aldrighetti, Elio Jovine, Roberto Montalti, Marco Vivarelli, Gian Luca Grazi, Giovanni Vennarecci, Giuseppe Maria Ettorre, Marco Massani, Nicolò Bassi, Christian Cotsoglou, Vincenzo Mazzaferro, Bruno NardoFabio Forchino, Alessandro Ferrero, Salvatore Gruttadauria, Giorgio Ercolani, Antonio Daniele Pinna

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Posthepatectomy liver failure is one of the most feared complications in extended hepatic resections. In 2012, a novel two-stage liver resection was developed, able to induce rapid and extensive hypertrophy by portal vein ligation and in situ liver splitting - Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS). The technique became more widely employed but its use remained controversial due to reporting of high complication and mortality rates. Method: A national audit was performed to gather information about the safety of the procedure and to better understand the complications. The audit was offered to all high-volume hepatobiliary centers in Italy. Results: Of all Italian centers approached in January 2012, 12 centers with experience in ALPPS enrolled and participated in collection of data. Fifty patients underwent ALPPS between 2012 and 2014. In 48/50 patients completion of hepatectomy was performed successfully. Major morbidity occurred in 54% with a 20% 90-day mortality. Uni- and multivariate analysis showed that ALPPS for cholangiocarcinoma and a peak of bilirubin over 5 mg/dl between stages was associated with increase of 90-day mortality and worse survival. Discussion: It is proposed that a moratorium be introduced for classic ALPPS in cholangiocarcinoma and to abort ALPPS in patients who develop an interstage increase in bilirubin, due to the high risk of liver failure and mortality.

Original languageEnglish
Pages (from-to)419-427
Number of pages9
JournalHPB
Volume18
Issue number5
DOIs
Publication statusPublished - May 1 2016

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Cholangiocarcinoma
Mortality
Liver
Liver Failure
Hepatectomy
Portal Vein
Bilirubin
Ligation
Hypertrophy
Italy
Multivariate Analysis
Morbidity
Safety
Survival

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Serenari, M., Zanello, M., Schadde, E., Toschi, E., Ratti, F., Gringeri, E., ... Pinna, A. D. (2016). Importance of primary indication and liver function between stages: Results of a multicenter Italian audit of ALPPS 2012-2014. HPB, 18(5), 419-427. https://doi.org/10.1016/j.hpb.2016.02.003

Importance of primary indication and liver function between stages : Results of a multicenter Italian audit of ALPPS 2012-2014. / Serenari, Matteo; Zanello, Matteo; Schadde, Erik; Toschi, Elena; Ratti, Francesca; Gringeri, Enrico; Masetti, Michele; Cillo, Umberto; Aldrighetti, Luca; Jovine, Elio; Montalti, Roberto; Vivarelli, Marco; Grazi, Gian Luca; Vennarecci, Giovanni; Ettorre, Giuseppe Maria; Massani, Marco; Bassi, Nicolò; Cotsoglou, Christian; Mazzaferro, Vincenzo; Nardo, Bruno; Forchino, Fabio; Ferrero, Alessandro; Gruttadauria, Salvatore; Ercolani, Giorgio; Pinna, Antonio Daniele.

In: HPB, Vol. 18, No. 5, 01.05.2016, p. 419-427.

Research output: Contribution to journalArticle

Serenari, M, Zanello, M, Schadde, E, Toschi, E, Ratti, F, Gringeri, E, Masetti, M, Cillo, U, Aldrighetti, L, Jovine, E, Montalti, R, Vivarelli, M, Grazi, GL, Vennarecci, G, Ettorre, GM, Massani, M, Bassi, N, Cotsoglou, C, Mazzaferro, V, Nardo, B, Forchino, F, Ferrero, A, Gruttadauria, S, Ercolani, G & Pinna, AD 2016, 'Importance of primary indication and liver function between stages: Results of a multicenter Italian audit of ALPPS 2012-2014', HPB, vol. 18, no. 5, pp. 419-427. https://doi.org/10.1016/j.hpb.2016.02.003
Serenari, Matteo ; Zanello, Matteo ; Schadde, Erik ; Toschi, Elena ; Ratti, Francesca ; Gringeri, Enrico ; Masetti, Michele ; Cillo, Umberto ; Aldrighetti, Luca ; Jovine, Elio ; Montalti, Roberto ; Vivarelli, Marco ; Grazi, Gian Luca ; Vennarecci, Giovanni ; Ettorre, Giuseppe Maria ; Massani, Marco ; Bassi, Nicolò ; Cotsoglou, Christian ; Mazzaferro, Vincenzo ; Nardo, Bruno ; Forchino, Fabio ; Ferrero, Alessandro ; Gruttadauria, Salvatore ; Ercolani, Giorgio ; Pinna, Antonio Daniele. / Importance of primary indication and liver function between stages : Results of a multicenter Italian audit of ALPPS 2012-2014. In: HPB. 2016 ; Vol. 18, No. 5. pp. 419-427.
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AU - Toschi, Elena

AU - Ratti, Francesca

AU - Gringeri, Enrico

AU - Masetti, Michele

AU - Cillo, Umberto

AU - Aldrighetti, Luca

AU - Jovine, Elio

AU - Montalti, Roberto

AU - Vivarelli, Marco

AU - Grazi, Gian Luca

AU - Vennarecci, Giovanni

AU - Ettorre, Giuseppe Maria

AU - Massani, Marco

AU - Bassi, Nicolò

AU - Cotsoglou, Christian

AU - Mazzaferro, Vincenzo

AU - Nardo, Bruno

AU - Forchino, Fabio

AU - Ferrero, Alessandro

AU - Gruttadauria, Salvatore

AU - Ercolani, Giorgio

AU - Pinna, Antonio Daniele

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