Associating Liver Partition and Portal vein ligation for Staged hepatectomy after pre‐operative chemotherapy

摘要

Background Recently a procedure termed ‘Associating Liver Partition and Portal vein ligation for Staged hepatectomy’ ( ALPPS ) was developed to increase the resectability of marginally resectable or locally unresectable liver tumours. This study focused on the application of ALPPS in patients with advanced colorectal liver metastases ( CRLM ) and pre‐operative chemotherapy, with the aim to investigate whether the latter still allows for sufficient hypertrophy of the future liver remnant (FLR) following the first step of ALPPS . Methods Retrospective analysis was performed on six patients suffering from advanced CRLM . Analyses comprised demographical and basic clinical data, the perioperative courses as well as short‐ and long‐term outcomes. Results All patients presented with bilobular CRLM and pre‐operative chemotherapy of at least 6 months. Extended right hemihepatectomy was performed in all cases, four patients additionally received atypical resections in segments II / III . Mean FLR prior to step 1 of ALPPS was 397.9?cm 3 (121–753?cm 3 ), on average representing 20.9% of the total liver volume (13.2–27.1%). A mean hypertrophy of the FLR of 67.9% (32.5–94.1%) was achieved. Overall, severe morbidity (Dindo Clavien 3a) occurred in two patients. Following completion of ALPPS , mean post‐operative disease‐free survival was 5.7 months (2.6–8.9 months). Conclusion Despite pre‐operative chemotherapy, ALPPS seems to result in adequate liver hypertrophy, preventing post‐operative small‐for‐size syndrome. However, there might be a high risk of tumour recurrence in patients with an aggressive tumour biology.