Authors
Navmatulya A.Yu.1, Cikoridze M.Yu.1, Al’muhametova F.R.1, Caregorodcev A.E.1, Bratov O.Z.1, Savchuk S.A.1, Kuznecov A.I.1, Gel’fond V.M.1, Zagryadskih A.S.1, Chernobrivceva V.V.1, Miroshnikov B.I.1, Egorenkov V.V.1, Moiseenko V.M.1, Solov’ev I.A.3
1 Saint-Petersburg clinical scientific and practical center for specialized types of medical care (oncological), Saint-Petersburg
2 S.M. Kirov Military medical academy, St. Petersburg
3 Mariinsky Hospital, St. Petersburg
Abstract
Colorectal сancer is the third leading cause of cancer death in Russia. Upon initial detection of a tumor, synchronous liver metastases are detected in 30–50% of patients. Two-stage liver resection is often the only option for radical surgical treatment of patients with massive metastatic liver disease by preventing postresection liver failure.
Objective: to assess the possibility of ALPPS liver resections in patients with colorectal cancer metastases.
Material and methods. Extended hepatectomy according to the ALPPS was performed in 18 patients with massive bilobar liver lesions and with planned future liver remnants about ≤30%. The average patients’ age was 61.3±8.4 years. The first stage of surgical treatment included complete (n = 13) or partial (n = 5) liver splitting along the falciform ligament up to the inferior vena cava retrohepatic segment with portal vein right branch ligation. The second stage was an extended right-sided hepatectomy.
Results. Duration of the first stage was 171.6±55.5 min, blood loss was 170.9±87.8 ml. The second stage was performed after 58.2±26.7 days. The hypertrophy’s rate was 85.2±8.5%, and the remaining parenchyma volume to the liver total volume ratio increased from 21.06±2.4% to 33.1±2.8%. The second stage’s duration was 213.2±90.2 min, blood loss was 546.4±297.7 ml. Complications developed in 7 patients: acute liver failure (n = 2), biliary fistula (n = 3), common bile duct stricture (n = 1), liver resection edge bleeding (n = 1). 1 patient died in the postoperative period. The disease progression during the year was observed in 10 out of 17 patients (58.8%). The overall 1-year survival rate is 66.6%.
Conclusion. Two-stage liver resection ALPPS allows expanding the radical treatment possibility in patients with initially unresectable or conditionally unresectable colorectal cancer liver metastases.
Keywords: colorectal cancer, liver metastases, liver resection, extended right hepatectomy, ALPPS, acute liver failure.
References
1. Schnitzbauer AA, Lang SA, Goessmann H, et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg. 2012; 255(3): 405-414. doi: 10.1097/SLA.0b013e31824856f5.
2. Nadalin S, Capobianco I, Li J, et al. Indications and Limits for Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS). Lessons Learned from 15 Cases at a Single Centre. Zeitschrift Für Gastroenterologie. 2014; 52(01): 35-42. doi: 10.1055/s-0033-1356364.
3. Per Sandström, Bård I Røsok, Ernesto Sparrelid, et al. ALPPS Improves Resectability Compared With Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastasis Results From a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial). Ann Surg. 2018; 267(5): 833-840. doi: 10.1097/SLA.0000000000002511.
4. Voskanyan SE, Chuchuyev ES, Artemiyev AI. et al. Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) in focal liver diseases management. Pirogov Russian Journal of Surgery. 2018; 2: 39-44. (In Russ). doi: 10.17116/hirurgia2018239-44.
5. Dokmak S, Belghiti J. Which Limits to the «ALPPS» Approach. Ann Surg. 2012; 256(3): e6. doi: 10.1097/sla.0b013e318265fd64.
6. Chaychenko DV, Nadvigova EA, Vazhenin AV, Privalov AV. Immediate results of the ALPPS procedure in patients with extensive metastatic liver disease. Russian Journal of oncology. 2014; 19(4): 51-52. (In Russ).
7. Skipenko OG, Chardarov NK, Bagmet NN, et al. Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) — new opportunity in two-stage liver resection in patients with colorectal cancer metastases. Khirurgiia. 2014; 9: 23-29. (In Russ).
8. Kozyrin IA, Ermakov NA, Lyadov VK, Kovalenko ZA. Experience of two-staged liver resection (ALPPS). Pirogov Russian Journal of Surgery. 2014; 12: 24-28. (In Russ).
9. Dimitri A. Raptis, Michael Linecker, Patryk Kambakamba, et al. Defining Benchmark Outcomes for ALPPS. Ann Surg. 2019; 270(5): 835-841. doi: 10.1097/SLA.0000000000003539.
10. Liu Y, Yang Y, Gu S, Tang K. A systematic review and meta-analysis of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) versus traditional staged hepatectomy. Medicine. 2019; 98(15): e15229. doi: 10.1097/MD.0000000000015229.
11. Pim B. Olthof, Andreas A. Schnitzbauer, Erik Schadde. The HPB controversy of the decade: 2007–2017 — Ten years of ALPPS. Eur J Surg Oncol. 2018; 44(10): 1624-1627. doi: 10.1016/j.ejso.2018.06.005.
