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Evolution of minimally invasive techniques and surgical outcomes of ALPPS in Italy: a comprehensive trend analysis over 10 years from a national prospective registry

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A Correction to this article was published on 11 May 2023

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Abstract

Background

Since 2012, Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has encountered several modifications of its original technique. The primary endpoint of this study was to analyze the trend of ALPPS in Italy over a 10-year period. The secondary endpoint was to evaluate factors affecting the risk of morbidity/mortality/post-hepatectomy liver failure (PHLF).

Methods

Data of patients submitted to ALPPS between 2012 and 2021 were identified from the ALPPS Italian Registry and evaluation of time trends was performed.

Results

From 2012 to 2021, a total of 268 ALPPS were performed within 17 centers. The number of ALPPS divided by the total number of liver resections performed by each center slightly declined (APC = − 2.0%, p = 0.111). Minimally invasive (MI) approach significantly increased over the years (APC = + 49.5%, p = 0.002). According to multivariable analysis, MI completion of stage 1 was protective against 90-day mortality (OR = 0.05, p = 0.040) as well as enrollment within high-volume centers for liver surgery (OR = 0.32, p = 0.009). Use of interstage hepatobiliary scintigraphy (HBS) and biliary tumors were independent predictors of PHLF.

Conclusions

This national study showed that use of ALPPS only slightly declined over the years with an increased use of MI techniques, leading to lower 90-day mortality. PHLF still remains an open issue.

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Acknowledgements

ALPPS Italian Registry Collaborators Stefania Camagni (Unit of Hepato-biliary Surgery and Liver Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy), Fabio Forchino (Department of General and Oncological Surgery, Mauriziano Hospital “Umberto I”, Turin, Italy), Enrico Gringeri (Hepatobiliary and Liver Transplantation Unit, University of Padua, Padua, Italy), Salvatore Gruttadauria (Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione, University of Pittsburgh Medical Center, Italy, Palermo, Italy), Paolo Magistri (Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy), Bruno Nardo (General and Oncological Surgery Unit, Department of Surgery, Annunziata Hospital, Cosenza, Italy), Matteo Ravaioli (General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, Bologna, Italy), Fabrizio Romano (School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy), Maurizio Romano (Department of Surgical, Oncological and Gastroenterological Science, University of Padua; Hepatobiliary and Pancreatic Surgery Unit, Treviso Hospital, Italy), Andrea Scarinci (Division of Hepatobiliary pancreatic Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy), Matteo Virdis (Department of Surgery, Division of HPB, General Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy), Giacomo Zanus (Department of Surgical, Oncological and Gastroenterological Science, University of Padua; Hepatobiliary and Pancreatic Surgery Unit, Treviso Hospital, Italy).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Sant’Orsola-Malpighi Hospital, Bologna, Italy

    Matteo Serenari, Matteo Cescon & Matteo Ravaioli

  2. Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Matteo Serenari, Matteo Cescon & Elio Jovine

  3. Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy

    Francesca Ratti & Luca Aldrighetti

  4. Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy

    Nicola Guglielmo & Giuseppe Maria Ettorre

  5. Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, Bologna, Italy

    Matteo Zanello & Elio Jovine

  6. HPB Surgery and Transplantation Unit, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Ancona, Italy

    Federico Mocchegiani & Marco Vivarelli

  7. Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Jacopo Lenzi

  8. Department of Organ Failure and Transplantation, ASST Giovanni XXIII, Bergamo, Italy

    Michele Colledan & Stefania Camagni

  9. Department of Medicine and Surgery, Università di Milano, Bicocca, Italy

    Michele Colledan

  10. Department of Surgery, Division of HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy

    Vincenzo Mazzaferro & Matteo Virdis

  11. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

    Vincenzo Mazzaferro

  12. General Surgery 2 - Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy

    Umberto Cillo & Enrico Gringeri

  13. Department of General and Oncological Surgery, Mauriziano Hospital Umberto I, Turin, Italy

    Alessandro Ferrero & Fabio Forchino

  14. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy

    Fabrizio Di Benedetto & Paolo Magistri

  15. Regional Center for HPB Surgery, Regional Hospital of Treviso, Treviso, Italy

    Marco Massani

  16. Division of Hepatobiliarypancreatic Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy

    Gianluca Grazi & Andrea Scarinci

  17. School of Medicine and Surgery, University of Parma, Parma, Italy

    Raffaele Dalla Valle

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Consortia

ALPPS Italian Registry

  • Stefania Camagni
  • , Fabio Forchino
  • , Enrico Gringeri
  • , Salvatore Gruttadauria
  • , Paolo Magistri
  • , Bruno Nardo
  • , Matteo Ravaioli
  • , Fabrizio Romano
  • , Maurizio Romano
  • , Andrea Scarinci
  • , Matteo Virdis
  •  & Giacomo Zanus

Corresponding author

Correspondence to Elio Jovine.

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Disclosures

Dr. Matteo Serenari, Dr. Francesca Ratti, Dr. Nicola Guglielmo, Dr. Matteo Zanello, Prof. Federico Mocchegiani, Dr. Jacopo Lenzi, Prof. Michele Colledan, Prof. Vincenzo Mazzaferro, Prof. Umberto Cillo, Dott. Alessandro Ferrero, Prof. Matteo Cescon, Prof. Fabrizio Di Benedetto, Prof. Marco Massani, Prof. Gianluca Grazi, Prof. Raffaele Dalla Valle, Prof. Marco Vivarelli, Prof. Giuseppe Maria Ettorre, Prof. Luca Aldrighetti, Prof. Elio Jovine, Dr. Stefania Camagni, Dr. Fabio Forchino, Prof. Enrico Gringeri, Prof. Salvatore Gruttadauria, Dr. Paolo Magistri, Prof. Bruno Nardo, Prof. Matteo Ravaioli, Prof. Fabrizio Romano, Dr. Maurizio Romano, Dr. Andrea Scarinci, Dr. Matteo Virdis and Prof. Giacomo Zanus have no conficts of interest to disclose.

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The members of the ALPPS Italian Registry are listed in the acknowledgments.

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Serenari, M., Ratti, F., Guglielmo, N. et al. Evolution of minimally invasive techniques and surgical outcomes of ALPPS in Italy: a comprehensive trend analysis over 10 years from a national prospective registry. Surg Endosc 37, 5285–5294 (2023). https://doi.org/10.1007/s00464-023-09937-4

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