Abstract

Introduction: ALPPS has been recently introduced for liver volume augmentation in cases of right hepatectomy with insufficient future remnant liver volumen (RLV) and high risk of liver failure. We retrospectively analyzed our experience with ALPPS in order to evaluate the application of the procedure. Method: Patients referred to Hospital del Salvador with liver metastases from colorectal cancer between October 2011–April 2015 were included, according to eligibility and exclusion criteria. In first stage, right portal vein was ligated and liver split in the limit of II–III segments along falciform ligament. Volume gain was followed-up with CT-scan where was evaluated RLV, total liver volume (TLV), remnant liver volume to body weight (RLV/BW) ratio and median volume gain. Perioperative morbidity was classified according Clavien-Dindo classification. Results: 13 ALPPS procedures were performed, 7 male and 6 female patients aged 40 to 70 years. The preoperative RLV/BW ratio was < 0.5 with RLV range from 180–473 ml. After ALPPS the RLV increased up to 96,8% (35–214%, p < 0.05) in 19 days (7–89), equivalent to 30,07±13,7 ml/day. Grade Clavien-Dindo ≥IIIB complications occurred in 23% (3/13) of patients including hematoma of abdominal wall and intra-abdominal sepsis with surgical management, and a reversible postoperative liver failure. There was no ninety-day mortality. Conclusions: A significant volume increased was achieved with ALPPS in a period shorter than the time required to achieve similar liver augmentation with portal embolization/ligation, decreasing the risk of insufficient hypertrophy and chances of tumoral progression. Selection of candidates and morbidity/mortality rates require a careful interdisciplinary assessment.