Did the International ALPPS Meeting 2015 Have an Impact on Daily Practice The Hamburg Barmbek Experience of 58 Cases

Abstract

Background: ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was introduced only 10 years ago and has gained wide acceptance as a variation of staged procedures in liver surgery. It has been criticized for its high morbidity and mortality, which all centers reported in their initial series. Methods: After a world expert meeting in Hamburg in 2015 where all experts in the field met to discuss this method, caveats were extracted and formulated. We researched our complete prospective ALPPS database to see if the recommendations had any impact on outcome. Results: In total, we performed 58 ALPPS procedures in our center. 33 patients were operated on before, 25 after the meeting. Results in terms of morbidity and mortality were significantly better after the meeting, as were patient selection and strategy. Conclusion: In our own center's experience, the implementation of the meetings' recommendations and the information gathered through this valuable exchange had a dramatic impact on results. Having performed 58 ALPPS procedures in total, we can now conclude that ALPPS has become much safer in our hands since the 2015 meeting and that morbidity and mortality are no longer the issue to be discussed. Future research must focus on oncologic outcomes in these patients.

Rapid Induction of Liver Regeneration for Major Hepatectomy (REBIRTH): A Randomized Controlled Trial of Portal Vein Embolisation versus ALPPS Assisted with Radiofrequency

“…Data from this registry showed a liver failure rate (by ISGLS criteria) and a mortality rate of 30% and 8.8%, respectively [31]. In order to minimize the associated complications reported with this technique, various alternative methods have been proposed and named as variant ALPPS (tourniquet ALPPS, mini-ALPPS, partial ALPPS, hybrid ALPPS and our own RALPPS) [18,19,20,21,22,32,33]. Although there was no clear evidence that ALPPS or its variants should replace PVE or that variant ALPPS were superior to conventional ALPPS [24], there seemed to be a significant reduction in morbidity and mortality rates when comparing variant ALPPS with conventional ALPPS [18].…”

Mitochondrial function after associating liver partition and portal vein ligation for staged hepatectomy in an experimental model

“…Initially, ALPPS was associated with high morbidity (up to 80·6 per cent) and mortality (up to 28·7 per cent) rates 8 . Newer modifications (such as partial ALPPS and mini‐ALPPS) and strict patient selection have reduced the rate of complications, but liver failure and mortality remain problematic. There may be inadequate functional regeneration despite the volume increase.…”

Undifferentiated embryonal sarcoma of the liver treated with associating liver partition and portal vein ligation for staged hepatectomy in a young adult: A case report

“…The full spectrum of treatable liver lesions is evolving still [2,[11], [12], [13]]. However, an initial throwback of this procedure was the initial high rate of major complications, which could be reduced with a careful patient selection and avoiding possible risk factors [[14], [15], [16]].…”