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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

Schadde, Erik ; Ardiles, Victoria ; Slankamenac, Ksenija ; Tschuor, Christoph ; Sergeant, Gregory ; Amacker, Nadja ; Baumgart, Janine ; Croome, Kris ; Hernandez-Alejandro, Roberto ; Lang, Hauke ; de Santibaňes, Eduardo ; Clavien, Pierre-Alain

In: World Journal of Surgery, 2014, vol. 38, no. 6, p. 1510-1519

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    Titre
    • 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
    Auteur
    • Schadde, Erik. Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    • Ardiles, Victoria. Division of HPB Surgery and Liver Transplant Unit, Department of Surgery, Italian Hospital, Buenos Aires, Argentina
    • Slankamenac, Ksenija. Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    • Tschuor, Christoph. Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    • Sergeant, Gregory. Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    • Amacker, Nadja. Department of Radiology, University Hospital Zurich, Zurich, Switzerland
    • Baumgart, Janine. Department of Visceral Surgery and Transplantation, University of Mainz, Mainz, Germany
    • Croome, Kris. Division of HPB Surgery, Department of Surgery, Western University, London, ON, Canada
    • Hernandez-Alejandro, Roberto. Division of HPB Surgery, Department of Surgery, Western University, London, ON, Canada
    • Lang, Hauke. Department of Visceral Surgery and Transplantation, University of Mainz, Mainz, Germany
    • de Santibaňes, Eduardo. Division of HPB Surgery and Liver Transplant Unit, Department of Surgery, Italian Hospital, Buenos Aires, Argentina
    • Clavien, Pierre-Alain. Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • World Journal of Surgery, 2014, vol. 38, no. 6, p. 1510-1519. Springer US; http://www.springer-ny.com
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:325101
    Summary
    Background: Portal vein occlusion to increase the size of the future liver remnant (FLR) is well established, using portal vein ligation (PVL) or embolization (PVE) followed by resection 4-8weeks later. Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) combines PVL and complete parenchymal transection, followed by hepatectomy within 1-2weeks. ALPPS has been recently introduced but remains controversial. We compare the ability of ALPPS versus PVE or PVL for complete tumor resection. Methods: A retrospective review of all patients undergoing ALPPS or conventional staged hepatectomies using PVL or PVE at four high-volume HPB centres between 2003 and 2012 was performed. Patients with primary liver tumors and liver metastases were included. Primary endpoint was complete tumor resection. Secondary endpoints include 90-day mortality, complications, FLR increase, time to resection, and tumor recurrence. Results: Forty-eight patients with ALPPS were compared with 83 patients with conventional-staged hepatectomies. Eighty-three percent (40/48 patients) of ALPPS patients achieved complete resection compared with 66% (55/83 patients) in PVE/PVL (odds ratio 3.34, p=0.027). Ninety-day mortality in ALPPS and PVE/PVL was 15 and 6%, respectively (p=0.2). Extrapolated growth rate was 11 times higher in ALPPS (34.8cc/day; interquartile range (IQR) 26-49) compared with PVE/PVL (3cc/day; IQR2-6; p=0.001). Tumor recurrence at 1year was 54 versus 52% for ALPPS and PVE/PVL, respectively (p=0.7). Conclusions: This study provides evidence that ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors at the cost of a high mortality. The technique is promising but should currently not be used outside of studies and registries.