Yonsei Med J.  2021 Oct;62(10):918-927. 10.3349/ymj.2021.62.10.918.

Modified Procedures for ALPPS Based on a Risk-Reduced Strategy: Paralleled Clinical Evaluation at Multiple Institutions

• Kong YL
• Xing Y
• Li J
• Liu CL
• He XJ
• Wang C
• Chen JM
• Kong LH
• Han X
• Zhang HY

• KMID: 2520415
• DOI: http://doi.org/10.3349/ymj.2021.62.10.918

Abstract

Purpose
We compared the clinical outcomes of modified procedures for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) based on a risk-reduced strategy with those of classic ALPPS procedures in treating large liver carcinoma.
Materials and Methods
Short-term outcomes, increases in future liver remnant (FLR) and functional FLR (FFLR), and overall survival (OS) were compared between 45 consecutive patients treated with modified ALPPS procedures and 34 patients treated with classic ALPPS procedures.
Results
Clinical outcomes after the 1st-stage operation markedly improved with the modified procedures. Although the proportions of liver cirrhosis and hepatocellular carcinoma were higher in the modified group, the mortality and incidence of severe complications did not increase. FLR and FFLR hypertrophy at 1 week after the 1st-stage operation were similar in both groups; however, kinetic growth rates in the modified group were lower. OS rates were similar.
Conclusion
Modified ALPPS procedures could be safely applied to provide long-term survival for patients with liver cirrhosis without sufficient FLR.

Keyword

ALPPS; liver carcinoma; liver cirrhosis; complication; survival