ALPPS for primary and secondary liver tumors

• ALPPS for hepatocellular carcinoma.
• ALPPS for locally advanced HCC with portal vein invasion.
• Future liver remnant growth after ALPPS in normal and cirrhotic livers.
• Technical and oncological feasibility of ALPPS in cirrhotic patients with HCC.

IntroductionTo report our experience on associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with liver tumors.MethodsALPPS is a surgical technique that allows hepatic resection after rapid liver hypertrophy.ResultsThirteen operations were performed: 8 for hepatocellular carcinoma (HCC) with liver cirrhosis (LC) and 5 for colorectal liver metastases (CRLM, n = 3) and cholangiocarcinoma (CC, n = 2) in normal livers (NL). Of the 11 men (85%), the median age was 60 years (range 36–74). Six (75%) HCC patients had BCLC stage C and 2 (25%) had BCLC stage B disease. The median % future liver remnant (FLR) volume increase was 71.7% in patients with LC and 64.8% in NL (p = 0.44). Twelve patients achieved a sufficient FLR growth after the first stage (92.3% efficacy). Four right trisectorectomies and 9 right hepatectomies were performed. All patients completed the second stage (100% feasibility). R0 resection was achieved in all cases. The 90-day mortality rate was 23.1% (12.5% for HCC patients with LC vs 40% for CRLM and CC patients with NL, p = 0.13). After the first stage the overall morbidity rates were 62.5% and 80% (p = 0.61), whereas after the second stage they were 87.5% and 80% in patients with LC and NL respectively (p = 0.99). At a median follow-up of 15 months (range 1–27), the median DFS was 9 months (CI95% 6–12), and the 1yr-DFS was 42%. The median survival was 25 months (CI95% 10–40), and the 1-yr overall survival was 74%.ConclusionsALPPS induced a considerable and comparable FLR growth in HCC patients with liver cirrhosis and patients with CRLM and CC with normal liver parenchyma. HCC patients who underwent ALPPS had a high rate of macrovascular tumor involvement. A high rate of R0 resection is expected in properly selected patients.