Review of ALPPS Cases in the Freeman Hospital

Nicole Gull

Introduction
The ALPPS (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy) procedure is a novel surgical approach for the management of primary and secondary liver cancers, first described in the literature in 2012. The aim of this review was to evaluate the effectiveness of ALPPS procedures in our centre and compare our results to those in the literature.

Methods
The notes from the first five ALPPS cases in the Freeman Hospital (one in 2015 and the remaining in 2017/18) were retrospectively reviewed. The future liver remnant (FLR) volumes before stage one and two were recalculated for the study by the same radiologist. Complications were recorded using the Clavien-Dindo classification.

Results
Four patients (two male and two female, ages 56-64) were operated on for colorectal liver metastases, and one patient (a male aged 72) for hepatocellular carcinoma. The mean increase in FLR volume was 76% (range 47-113%), with a mean time of 11 days (range 7-14 days) between stages. The mean length of stay in hospital was 49 days (range 12-126 days). 40% of patients developed a postoperative complication of Clavien-Dindo 3b or above, with one requiring ITU admission. 90-day mortality was zero. 

Conclusion
Although our sample size is small, our results are equivocal to those reported in the literature. This new technique is very encouraging, providing patients with previously unresectable tumours due to low FLR volumes a viable surgical option and therefore a chance of cure.