Z Gastroenterol 2018; 56(01): E2-E89
DOI: 10.1055/s-0037-1612807
Poster Visit Session IV Tumors, Liver Surgery and Transplantation – Saturday, January 27, 2018, 8:30am – 9:15am, Foyer area West Wing
Georg Thieme Verlag KG Stuttgart · New York

Efficacy of ALPPS procedure versus portal vein embolization for hypertrophy of future liver remnant in right trisectionectomy: quality and outcome

T Tsui
1   UKE Hamburg- Eppendorf, Department of General, Visceral and Thoracic Surgery, Hamburg
,
A Heumann
1   UKE Hamburg- Eppendorf, Department of General, Visceral and Thoracic Surgery, Hamburg
,
B Wellge
1   UKE Hamburg- Eppendorf, Department of General, Visceral and Thoracic Surgery, Hamburg
,
J Izbicki
1   UKE Hamburg- Eppendorf, Department of General, Visceral and Thoracic Surgery, Hamburg
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2018 (online)

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Objective:

To compare the efficacy of ALPPS (Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy) procedure versus portal vein embolisation in the induction of liver hypertrophy.

Background:

The in situ split of the liver and portal vein ligation/transection (ALPPS) represents an innovative surgical technique to induce a rapid hypertrophy of future liver remnant. In the study we compared the degree and the quality of liver hypertrophy of the new technique with conventional portal vein embolization.

Methods:

we collected the data of 36 consecutive patients who underwent right trisectionectomy from 2009 – 2012. Twenty-one of 36 patients received right portal vein and Seg IV portal vein embolization to induce the hypertrophy of future liver remnant (PVE). Fifteen of 36 patients received the in situ split and right portal vein transection after implementation of the new technique (ALPPS). The efficacy and clinical outcomes of the two techniques for the induction of the hypertrophy of future liver remnant (FLR) were analyzed.

Results:

There was no significant difference in terms of patient characteristics between the groups. In situ split induced comparable hypertrophy of the FLR (median: 526mL in ALPPS group vs. 428 mL in PVE group, P = ns) in a significantly shorter time (median 9 days vs. 30 days, P = 0.0001). The percentage of the volume of the FLR was 35% of estimated standard liver volume (ESLV) that was higher than those in PVE group (26.8%). The delta% of ESLV was 16% in ALPPS group, which is significantly higher than those in PVE group (median 8.2%). However hepatobiliary scintigraphy showed the quality of the liver hypertrophy in ALPPS group varied to that in the PVE group. Perioperative data showed that there was a lower incidence of small-for-size syndrome in ALPPS group as compared with PVE group. In addition, there was no difference in terms of rate of postoperative complications, hospital mortality and the one-year, three-year and tumor-free survival of patients after the surgery.

Conclusions:

The ALPPS is superior to PVE for the induction of rapid hypertrophy of future liver remnant. The quality of liver hypertrophy in ALPPS is various to that with PVE. The short-term results in terms of overall and tumor-free survival are comparable.