Dr. Suzana Buac
Dr. Roberto Hernandez-Alejandro
London Health Sciences Centre
London, ON, Canada
Project title:
Are there variations in surgical technique for ALPPS?
Hypothesis:
There are 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.
Background:
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.