TY - JOUR
T1 - Importance of primary indication and liver function between stages
T2 - Results of a multicenter Italian audit of ALPPS 2012-2014
AU - Serenari, Matteo
AU - Zanello, Matteo
AU - Schadde, Erik
AU - Toschi, Elena
AU - Ratti, Francesca
AU - Gringeri, Enrico
AU - Masetti, M.
AU - Cillo, U.
AU - Aldrighetti, Luca
AU - Jovine, Elio
AU - Montalti, R.
AU - Vivarelli, Marco
AU - Grazi, Gian Luca
AU - Vennarecci, Giovanni
AU - Ettorre, Giuseppe Maria
AU - Massani, Marco
AU - Bassi, N.
AU - Cotsoglou, Christian
AU - Mazzaferro, Vincenzo
AU - Nardo, B.
AU - Forchino, Fabio
AU - Ferrero, Alessandro
AU - Gruttadauria, Salvatore
AU - Ercolani, G.
AU - Pinna, A. D.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.hpb.2016.02.003
DO - 10.1016/j.hpb.2016.02.003
M3 - Article
VL - 18
SP - 419
EP - 427
JO - HPB
JF - HPB
SN - 1365-182X
IS - 5
ER -