Marcelo Enne1, Erik Schadde2, Bergthór Björnsson3, Roberto Hernandez Alejandro4, Klaus Steinbruck5, Eduardo Viana6, Ricardo Robles Campos7, Massimo Malago8, Pierre-Alain Clavien9, Eduardo De Santibanes10, Brice Gayet11. 1. Ipanema Federal Hospital, Brazil. Electronic address: marceloenne@gmail.com. 2. Cantonal Hospital Winterthur, Canton of Zurich, Switzerland; Rush University Medical Center, USA. 3. Linköping University, Sweden. 4. Department of Surgery, University of Rochester, Rochester, NY, USA. 5. Bonsucesso Federal Hospital, Brazil. 6. Ipanema Federal Hospital, Brazil. 7. Virgen de la Arrixaca University Hospital, Spain. 8. Royal Free Hospital, United Kingdom. 9. University Hospital Zurich, Switzerland. 10. Hospital Italiano, Argentina. 11. Institut Mutualiste Montsouris, France.
Abstract
BACKGROUND: A minimum future liver remnant (FLR) of 30% is required to avoid post hepatectomy liver failure (PHLF). Portal vein occlusion (PVO) is the main strategy to induce hypertrophy of the FLR, but some patients will not reach sufficient FLR hypertrophy to enable resection. Recently ALPPS has emerged as a "Salvage Procedure" for PVO failure. The aim of this study was to report the short term outcomes of ALPPS following PVO failure. METHODS: A retrospective analysis of patients enrolled within the international ALPPS Registry between October 2012 and November 2015 (NCT01924741) was performed. Patients with documented PVO failure were included. The outcomes reported included feasibility, FLR growth rate and safety of ALPPS. Complications were recorded as per Clavien-Dindo classification. RESULTS: From 510 patients enrolled in the Registry there were 22 patients with previous PVO failure. Two patients were excluded due to missing data and twenty patients were analysed. All of them completed the proposed ALPPS with a medium FLR increase of 88% (23-115%) between two stages and no 90-day mortality. CONCLUSION: In experienced centers, ALPPS following PVO failure is feasible and safe. The FLR hypertrophy was similar to other ALPPS series. ALPPS is a potential rescue strategy after PVO failure.
BACKGROUND: A minimum future liver remnant (FLR) of 30% is required to avoid post hepatectomy liver failure (PHLF). Portal vein occlusion (PVO) is the main strategy to induce hypertrophy of the FLR, but some patients will not reach sufficient FLR hypertrophy to enable resection. Recently ALPPS has emerged as a "Salvage Procedure" for PVO failure. The aim of this study was to report the short term outcomes of ALPPS following PVO failure. METHODS: A retrospective analysis of patients enrolled within the international ALPPS Registry between October 2012 and November 2015 (NCT01924741) was performed. Patients with documented PVO failure were included. The outcomes reported included feasibility, FLR growth rate and safety of ALPPS. Complications were recorded as per Clavien-Dindo classification. RESULTS: From 510 patients enrolled in the Registry there were 22 patients with previous PVO failure. Two patients were excluded due to missing data and twenty patients were analysed. All of them completed the proposed ALPPS with a medium FLR increase of 88% (23-115%) between two stages and no 90-day mortality. CONCLUSION: In experienced centers, ALPPS following PVO failure is feasible and safe. The FLR hypertrophy was similar to other ALPPS series. ALPPS is a potential rescue strategy after PVO failure.
Authors: R Vera; E González-Flores; C Rubio; J Urbano; M Valero Camps; J J Ciampi-Dopazo; J Orcajo Rincón; V Morillo Macías; M A Gomez Braco; G Suarez-Artacho Journal: Clin Transl Oncol Date: 2019-07-29 Impact factor: 3.405
Authors: Nadja Lehwald-Tywuschik; Sascha Vaghiri; Jan Schulte Am Esch; Salman Alaghmand; Yan Klosterkemper; Lars Schimmöller; Anja Lachenmayer; Hany Ashmawy; Andreas Krieg; Stefan A Topp; Alexander Rehders; Wolfram Trudo Knoefel Journal: BMC Surg Date: 2020-04-06 Impact factor: 2.102