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ALPPS Technique Modification and Impact on Outcomes

Suzana Buac, Roberto Hernandez-Alejandro
Department / Institution: 
London Health Sciences Centre, London, Ontario, Canada
Date Project Approved: 
Thursday, 10 July, 2014
Project Status: 
The ALPPS (Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy) is a complex procedure combining liver partition with portal vein ligation followed by a second operation to remove the deportalized diseased portion of the liver. The initial experience with ALPPS suggested that the functional liver remnant volume increase was greater than with previous techniques and allowed for removal of the deportalized portion of the liver within 1-2 weeks following the first surgery. Since then, ALPPS has been implemented more widely in an attempt for curative resection for patients with otherwise small functional liver remnants. However, ALPPS may also be associated with a higher postoperative morbidity and mortality rates and it has caused some controversy with respect to its benefits and potential dangers. Specific variations in the technical aspects of the ALPPS procedure likely exist in different surgical centers worldwide and we aim to elucidate some of these differences in order to attempt a consensus.
To assess the variations in surgical technique for ALPPS among different centres including the approach to hepatoduodenal ligament dissection, preservation of the segment 4 arterial branch and preservation of the middle hepatic vein.
Study design: A retrospective analysis of all patients registered in the ALPPS registry. Study questions: How do surgical techniques for performing ALPPS vary amongst surgeons and surgical centers? Specifically our study aims to look at the techniques of skeletonization of the hepatoduodenal ligament, preservation of the segment 4 arterial branch and preservation of the middle hepatic vein. Due to the coding of the ALPPS registry with respect to dissection technique, the only variable we would be able to study directly from the registry would be whether a “complete lymphadenectomy [was] performed”. As such, and in light of an upcoming consensus conference on ALPPS, we aim to identify centers worldwide that have performed more than 8 ALPPS procedures in order to survey ALPPS surgeons on technique variability. This initial study would simply identify centers with a sufficiently high volume of ALPPS procedure using the ALPPS registry. Subsequently, those centers will be contacted and invited to complete a survey on ALPPS surgical techniques, specifically focussing on hepatoduodenal ligament skeletonization, preservation of the segment 4 arterial branch and preservation of the middle hepatic vein.


University Hospital Zurich
Department of Surgery
Raemistrasse 100
8091 Zurich, Switzerland


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