Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 10, 2017; 8(4): 351-359
Published online Aug 10, 2017. doi: 10.5306/wjco.v8.i4.351
Rescue associating liver partition and portal vein ligation for staged hepatectomy after portal embolization: Our experience and literature review
Charlotte Maulat, Antoine Philis, Bérénice Charriere, Fatima-Zohra Mokrane, Rosine Guimbaud, Philippe Otal, Bertrand Suc, Fabrice Muscari
Charlotte Maulat, Antoine Philis, Bérénice Charriere, Bertrand Suc, Fabrice Muscari, Department of Visceral Surgery, Toulouse-Rangueil University Hospital, 31059 Toulouse Cedex 9, France
Fatima-Zohra Mokrane, Philippe Otal, Department of Radiology, Toulouse-Rangueil University Hospital, 31059 Toulouse Cedex 9, France
Rosine Guimbaud, Department of Digestive Oncology, Toulouse-Rangueil University Hospital, 31059 Toulouse Cedex 9, France
Author contributions: Maulat C, Philis A, Charriere B and Muscari F performed research and wrote the paper; Mokrane FZ, Guimbaud R, Otal P and Suc B provided critical revision of the manuscript for important intellectual content.
Institutional review board statement: This study was reviewed and approved by the Toulouse University Hospital Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Fabrice Muscari, Professor, Department of Visceral Surgery, Toulouse-Rangueil University Hospital, 1 Avenue du Pr Jean Poulhès, 31059 Toulouse Cedex 9, France. muscari.f@chu-toulouse.fr
Telephone: +33-56-1322088 Fax: +33-56-1322936
Received: January 26, 2017
Peer-review started: February 8, 2017
First decision: May 10, 2017
Revised: June 5, 2017
Accepted: July 7, 2017
Article in press: July 10, 2017
Published online: August 10, 2017
Abstract
AIM

To report a single-center experience in rescue associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), after failure of previous portal embolization. We also performed a literature review.

METHODS

Between January 2014 and December 2015, every patient who underwent a rescue ALPPS procedure in Toulouse Rangueil University Hospital, France, was included. Every patient included had a project of major hepatectomy and a previous portal vein embolization (PVE) with insufficient future liver remnant to body weight ratio after the procedure. The ALPPS procedure was performed in two steps (ALPPS-1 and ALPPS-2), separated by an interval phase. ALPPS-2 was done within 7 to 9 d after ALPPS-1. To estimate the FLR, a computed tomography scan examination was performed 3 to 6 wk after the PVE procedure and 6 to 8 d after ALPPS-1. A transcystic stent was placed during ALPPS-1 and remained opened during the interval phase, in order to avoid biliary complications. Postoperative liver failure was defined using the 50-50 criteria. Postoperative complications were assessed according to the Dindo-Clavien Classification.

RESULTS

From January 2014 to December 2015, 7 patients underwent a rescue ALPPS procedure. Median FLR before PVE, ALPPS-1 and ALPPS-2 were respectively 263 cc (221-380), 450 cc (372-506), and 660 cc (575-776). Median FLR/BWR before PVE, ALPPS-1 and ALPPS-2 were respectively 0.4% (0.3-0.5), 0.6% (0.5-0.8), and 1% (0.8-1.2). Median volume growth of FLR was 69% (18-92) after PVE, and 45% (36-82) after ALPPS-1. The combination of PVE and ALPPS induced a growth of median initial FLR of +408 cc (254-513), leading to an increase of +149% (68-199). After ALPPS-2, 4 patients had stage I-II complications. Three patients had more severe complications (one stage III, one stage IV and one death due to bowel perforation). Two patients suffered from postoperative liver failure according to the 50/50 criteria. None of our patients developed any biliary complication during the ALPPS procedure.

CONCLUSION

Rescue ALPPS may be an alternative after unsuccessful PVE and could allow previously unresectable patients to reach surgery. Biliary drainage seems to reduce biliary complications.

Keywords: Rescue associating liver partition and portal vein ligation for staged hepatectomy, Associating liver partition and portal vein ligation for staged hepatectomy, Portal vein embolization, Liver resection, Future liver remnant

Core tip: Hepatic surgery appears as the best curative option for patients with primary or secondary malignant hepatic tumors. Several strategies have been developed to avoid postoperative liver failure, such as portal vein embolization (PVE). In 2012, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was developed. It induces rapid and extensive hypertrophy of the future liver remnant, but with high morbidity and mortality. Therefore, some authors have suggested that ALPPS should be performed only as a “rescue”, after failed PVE. We describe our results of rescue ALPPS after failure of previous PVE and we perform a literature review.