gms | German Medical Science

132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

Article

Send article

Consecutive successful ALPPS in 2 years without reoperation and mortality

Meeting Abstract

Search Medline for

  • Jun Li - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Florian Ewald - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Alexandros Kantas - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Andreas Koops - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Eike-Gert Achilles - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Lutz Fischer - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland
  • Bjoern Nashan - Universitätsklinikum Hamburg-Eppendorf, Klinik für Hepatobiliäre Chirurgie und Transplantationschirurgie, Hamburg, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch083

doi: 10.3205/15dgch083, urn:nbn:de:0183-15dgch0831

Published: April 24, 2015

© 2015 Li et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Introduction: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was reported as a procedure associated with a relevant morbidity and mortality. The current study aims to access the safety of ALPPS after the learning period.

Material and methods: Lessons from the initial learning period (November 2010 to April 2012), regarding the patient selection, surgical technique and perioperative management, were respected since ALPPS was introduced in authors institute in May 2012. Following instructions were followed:

1.
simplifying the stage I operation to avoid bile leakage, infection and unnecessary manipulation of the disease liver;
2.
choosing the length of the waiting time of average two weeks till stage II operation to avoid liver failure;
3.
regarding hilar cholangiocarcinoma as a contraindication.

The postoperative complication, mortality as well as the oncological efficacy were analyzed accordingly.

Results: 11 consecutive ALPPS have been performed by the first author for radical resection of colorectal liver metastasis (n=7), gall bladder carcinoma (n=2), intrahepatic cholangiocarcinoma (n=1), hepatocellular carcinoma (n=1). The efficacy of ALPPS in form of future liver remnant hypertrophy, completion of the tumor resection and residual tumor status were comparable to the results from the largest ALPPS registry. The postoperative complications were found in 9 of 11 patients without mortality. All complications were Clavien-Dindo classification grade I or II, except a grade IIIA in one patient undergoing right trisectionectomy with pancreaticoduodenectomy.

Conclusion: Being the first case series without severe complication and mortality after ALPPS, the authors found that by following the fundamental instructions mentioned above, ALPPS itself is a safe procedure.