gms | German Medical Science

Introduction: Patients presenting primary or metastatic liver tumor with no sufficient rest liver volume face the problem of resection. Preoperative portal vein embolization has so far been considered as the gold standard procedure to achieve the adequate left lateral volume. ALPPS has been recently introduced as surgical alternative to PVE.

Aim: To report our single centre experience with APPLS in 12 patients affected of CRLM and hilar CCA.

Material and methods: Indication to ALPPS: future liver remnant volume > 25% or RVBWR < 0.5. ALPPS procedure as reported by Schnitzbauer et al in Ann Surg 2012. Standardized data were collected from preoperative documentation (staging, demographics), intraoperative surgical protocols and postoperative care.

Results: Between 2010-2012 12 patients affected of CRLM (n=7) and hilar CCA (n=5) underwent a ALPPS. After a median of 12 days (10-15) the left lateral lobe reached a median volumetric increase of 150% (30-200%) of its original volumeSurgical complications according to Dindo-Clavien’s Classification:

grade I-III : 9 events

grade IV : 4 events (3 in CCA and 1 in CRLM)

grad V (i.e. mortality) : 2 events ( secondary biliary sepsis and MOF both in patients with hilar CCA)

Three patients (2 with CCA and 1 with CRLM) developed a small for size syndrome between POD 3 and 2. After a mean follow up of 8 month 10 patient are still alive and 2 patient had a tumor recurrence at 6 POM.

Conclusion: ALPPS showed good results in patients with CRLM, but higher complications rates in patients with hilar CCA mainly due to contamination of bile ducts through preoperative stenting and more difficult hilar preparation at the second phase of APPLS. In such cases ALPPS should be contraindicated and PVE preferred.