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ALPPS Procedure in Insufficient Hypertrophy After Portal Vein Embolization (PVE)

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Abstract

Background

The main limiting factor for major liver resections is the volume and function of the future remnant liver (FLR). Portal vein embolization (PVE) is now standard in most centers for preoperative hypertrophy of FLR. However, it has a failure rate of about 20–30 %. In these cases, the “Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy” (ALPPS) may represent a suitable and possibly the only alternative.

Methods

We performed a retrospective analysis of nine patients who had ALPPS following an insufficient hypertrophy after PVE. Computed tomography volumetry were performed before and after PVE as well as the first step of ALPPS. Furthermore, complications, 30-day mortality and outcome were analyzed.

Results

The FLR volume rose significantly by 77.7 ± 40.7 % (FLR/TLV: 34.9 ± 9.7 %) as early as 9 days after the first stage despite insufficient hypertrophy after preoperative portal vein embolization. Major complications (Grade > IIIb) occurred in 33 % of the patients, and 30-day mortality was 11.1 %. The OS at 1 and 2 years was 78 and 44 %. Four patients are presently still alive at a median of 33.4 (range 15–48) months (survival rate 44.4 %).

Conclusion

The ALPPS procedure could be a suitable alternative for patients following insufficient PVE or indeed the last chance of a potentially curative treatment in this situation. Nevertheless, the high morbidity and mortality rates and the lack of data on the long-term oncological outcome must also be taken into account.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    T. F. Ulmer, A. Andert, P. Bruners, W. Schoening, M. Schmeding & U. P. Neumann

  2. Department of General and Visceral Surgery, Sana Hospital Gerresheim, Graeulingerstr. 120, 40625, Duesseldorf, Germany

    C. M. Heidenhain

  3. Department of Diagnostic and Interventional Radiology, University Hospital of the RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    C. de Jong

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  1. T. F. Ulmer
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Correspondence to T. F. Ulmer.

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Ulmer, T.F., de Jong, C., Andert, A. et al. ALPPS Procedure in Insufficient Hypertrophy After Portal Vein Embolization (PVE). World J Surg 41, 250–257 (2017). https://doi.org/10.1007/s00268-016-3662-3

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