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Robotic ALPPS for primary and metastatic liver tumours: short-term outcomes versus open approach

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Abstract

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is one of the strategies available for patients initially unresectable. High risk of peri-operative morbidity and mortality limited its application and diffusion. We aimed to analyse short-term outcomes of robotic ALPPS versus open approach, to assess safety and reproducibility of this technique. A retrospective analysis of prospectively maintained databases at University of Modena and Reggio Emilia on patients that underwent ALPPS between January 2015 and September 2022 was conducted. The main aim of the study was to evaluate safety and feasibility of robotic approach, either full robotic or only first-stage robotic, compared to a control group of patients who underwent open ALPPS in the same Institution. 23 patients were included. Nine patients received a full open ALPPS (O-ALPPS), 7 received a full robotic ALPPS (R-ALPPS), and 7 underwent a robotic approach for stage 1, followed by an open approach for stage 2 (R + O-ALPPS). PHLF grade B-C after stage 1 was 0% in all groups, rising to 58% in the R + O-ALPPS group after stage 2 and remaining 0% in the R-ALPPS group. 86% of R-ALPPS cases were discharged from the hospital between stages 1 and 2, and median total in-hospital stay and ICU stay favoured full robotic approach as well. This contemporary study represents the largest series of robotic ALPPS, showing potential advantages from full robotic ALPPS over open approach, resulting in reduced hospital stay and complications and lower incidence of 90-day mortality.

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Data availability

Preliminary data of this study have been presented during the 2022 ILTS meeting in Istanbul (May 4–7, 2022) and awarded with the Young Investigator Award to Dr. Paolo Magistri.

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Acknowledgements

The authors thank the Modena ARTS Foundation (Academy for Robotic and Transplant Surgery) for the support to clinical research.

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. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena “Policlinico”, University of Modena and Reggio Emilia, 41124, Modena, Italy

    Paolo Magistri, Cristiano Guidetti, Barbara Catellani, Daniela Caracciolo, Roberta Odorizzi, Gian Piero Guerrini, Stefano Di Sandro & Fabrizio Di Benedetto

  2. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy

    Samuele Frassoni & Vincenzo Bagnardi

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  1. Paolo Magistri
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  2. Cristiano Guidetti
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Contributions

Conception and design of the study: PM, FDB. Acquisition of data: CG, BC, DC, RO. Analysis and interpretation of data: SF, VB, GPG, SDS. Drafting: PM, SF, CG. Critical revision: FDB, BC, DC, RO, GPG, SDS, VB. Final approval: FDB, PM, CG, BC, DC, RO, SF, VB, GPG, SDS.

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Correspondence to Fabrizio Di Benedetto.

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The study was conducted according to the principles of the Helsinki declaration.

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All patients signed an informed consent for data collection and analysis.

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The study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Magistri, P., Guidetti, C., Catellani, B. et al. Robotic ALPPS for primary and metastatic liver tumours: short-term outcomes versus open approach. Updates Surg 76, 435–445 (2024). https://doi.org/10.1007/s13304-023-01680-8

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