Efficacy of Technical Modifications to the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure

Elias Khajeh, MD, MPH; Ali Ramouz, MD; Arash Dooghaie Moghadam, MD; Ehsan Aminizadeh, MD, MPH; Omid Ghamarnejad, MD; Sadeq Ali-Hassan-Al-Saegh, MD; Ahmed Hammad, MD; Saeed Shafiei, MD; Sepehr Abbasi Dezfouli, MD; Arash Nickkholgh, MD; Mohammad Golriz, MD; Gil Goncalves, MD; Ricardo Rio-Tinto, MD; Carlos Carvalho, MD; Katrin Hoffmann, MD; Pascal Probst, MD; Arianeb Mehrabi, MD

doi:10.1097/AS9.0000000000000221

Annals of Surgery Open (Dec 2022)

Efficacy of Technical Modifications to the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure

Elias Khajeh, MD, MPH,
Ali Ramouz, MD,
Arash Dooghaie Moghadam, MD,
Ehsan Aminizadeh, MD, MPH,
Omid Ghamarnejad, MD,
Sadeq Ali-Hassan-Al-Saegh, MD,
Ahmed Hammad, MD,
Saeed Shafiei, MD,
Sepehr Abbasi Dezfouli, MD,
Arash Nickkholgh, MD,
Mohammad Golriz, MD,
Gil Goncalves, MD,
Ricardo Rio-Tinto, MD,
Carlos Carvalho, MD,
Katrin Hoffmann, MD,
Pascal Probst, MD,
Arianeb Mehrabi, MD

Affiliations

Elias Khajeh, MD, MPH: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Ali Ramouz, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Arash Dooghaie Moghadam, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Ehsan Aminizadeh, MD, MPH: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Omid Ghamarnejad, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Sadeq Ali-Hassan-Al-Saegh, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Ahmed Hammad, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Saeed Shafiei, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Sepehr Abbasi Dezfouli, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Arash Nickkholgh, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Mohammad Golriz, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Gil Goncalves, MD: † Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
Ricardo Rio-Tinto, MD: ‡ Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal
Carlos Carvalho, MD: § Department of Clinical Oncology, Digestive Unit, Champalimaud Clinical Centre, Lisbon, Portugal.
Katrin Hoffmann, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Pascal Probst, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany
Arianeb Mehrabi, MD: From the * Department of General, Visceral, and Transplantation Surgery, Ruprecht-Karls University, Heidelberg, Germany

DOI: https://doi.org/10.1097/AS9.0000000000000221
Journal volume & issue: Vol. 3, no. 4
p. e221

Abstract

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Objectives:. To compare the outcomes of modified-Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) techniques with those of conventional-ALPPS. Background:. ALPPS is an established technique for treating advanced liver tumors. Methods:. PubMed, Web of Science, and Cochrane databases were searched. The outcomes were assessed by single-arm and 2-arm analyses. Results:. Seventeen studies containing 335 modified-ALPPS patients were included in single-arm meta-analysis. The estimated blood loss was 267 ± 29 mL (95% confidence interval [CI], 210–324 mL) during the first and 662 ± 51 mL (95% CI, 562–762 mL) during the second stage. The operation time was 166 ± 18 minutes (95% CI, 131–202 minutes) during the first and 225 ± 19 minutes (95% CI, 188–263 minutes) during the second stage. The major morbidity rate was 14% (95% CI, 9%–22%) after the first stage. The future liver remnant hypertrophy rate was 65.2% ± 5% (95% CI, 55%–75%) and the interstage interval was 16 ± 1 days (95% CI, 14–17 days). The dropout rate was 9% (95% CI, 5%–15%). The overall complication rate was 46% (95% CI, 37%–56%) and the major complication rate was 20% (95% CI, 14%–26%). The postoperative mortality rate was 7% (95% CI, 4%–11%). Seven studies containing 215 patients were included in comparative analysis. The hypertrophy rate was not different between 2 methods (mean difference [MD], –5.01; 95% CI, –19.16 to 9.14; P = 0.49). The interstage interval was shorter for partial-ALPPS (MD, 9.43; 95% CI, 3.29–15.58; P = 0.003). The overall complication rate (odds ratio [OR], 10.10; 95% CI, 2.11–48.35; P = 0.004) and mortality rate (OR, 3.74; 95% CI, 1.36–10.26; P = 0.01) were higher in the conventional-ALPPS. Conclusions:. The hypertrophy rate in partial-ALPPS was similar to conventional-ALPPS. This shows that minimizing the first stage of the operation does not affect hypertrophy. Moreover, the postoperative overall morbidity and mortality rates were lower following partial-ALPPS.

Published in Annals of Surgery Open

ISSN: 2691-3593 (Online)
Publisher: Wolters Kluwer Health
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://journals.lww.com/aosopen/pages/default.aspx

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