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From conventional two-stage hepatectomy to ALPPS:Fifteen years of experience in a hepatobiliary surgery unit

Hepatobiliary & Pancreatic Diseases International 2021年第6期20卷 542-550页

作者： Javier Maupoey Ibáñez Eva María MontalváOrón Andrea BoscàRobledo Alonso Camacho Ramírez Ana Hernando Sanz Pablo Granero Castro alberto alegre delgado Rafael López-Andújar Hepatobiliary Surgery and Transplant Unit La Fe University and Polytechnic HospitalValenciaSpain Department of Radiology La Fe University and Polytechnic HospitalValenciaSpain

Background:Hepatectomy in patients with large tumor load may result in postoperative liver failure and associated complications due to excessive liver parenchyma *** two-stage hepatectomy(TSH)and associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)technique are possible solutions to this *** liver metastases(CRLM)is the most frequent indication,and there is a need to assess outcomes for both techniques to improve surgical and long-term oncological outcomes in these ***:A single-center retrospective study was designed to compare TSH with ALPPS in patients with initially unresectable bilateral liver tumors between January 2005 and January *** was performed from January 2012 onwards as the technique of ***-term overall survival(OS)and disease-free survival(DFS)were evaluated as primary outcome in CRLM *** morbidity,mortality and liver growth in all patients were also ***:A total of 38 staged hepatectomies were performed:17 TSH and 21 *** resection rate was 76.5%(n=13)in the TSH group and 85.7%(n=18)in the ALPPS group(P=0.426).Overall major morbidity(Clavien-Dindo≥3 a)(stage 1+stage 2)was 41.2%(n=7)in TSH and 33.3%(n=7)in ALPPS patients(P=0.389),and perioperative 90-day mortalities were 11.8%(n=2)vs.19.0%(n=4)in each group,respectively(P=0.654).Intention-to-treat OS rates at 1 and 5 years in CRLM patients for TSH(n=15)were 80%and 33%,and for ALPPS(n=17)76%and 35%,*** rates at 1 and 5 years were 36%and 27%in the TSH group vs.33%and 27%in the ALPPS group,***:ALPPS is an effective alternative to TSH in bilateral affecting liver tumors,allowing higher resection rate,but patients must be carefully *** CRLM patients similar long-term OS and DFS can be achieved with both techniques.

关键词： ALPPS Two-stage hepatectomy Colorectal liver metastases Posthepatectomy liver failure

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