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Is the ALPPS procedure effective in patients with fibrosis?

Martin Angele, Jan G. D’Haese
Department / Institution: 
University of Munich
Date Project Approved: 
Thursday, 12 June, 2014
Project Status: 
Application / Abstract: 
The “Associating Liver Partition with Portal vein ligation for Staged hepatectomy” (ALPPS) procedure has recently been successfully introduced for patients with advanced liver tumors [1]. However, the procedure remains controversial due to high morbidity and mortality rates. Accumulating evidence suggests that the ALPPS procedure should be limited to patients with colorectal liver metastases,. However marginally resectable HCC is are a common problem for liver surgeons . A recent analysis of the ALPPS registry found HCC in 17 patients had perioperative mortality after ALPPS of 12% and a Clavien-Dindo complication rate of > IIIb in 25% of patients. Our hypothesis is that the ALPPS procedure may be unsuitable for patients with HCC due to the underlying liver disease Published data on patients with HCC and underlying liver disease undergoing ALPPS is very limited. So far, only one case series consisting of only 3 HCC cases has been published [2]. Liver fibrosis has previously been shown to substantially reduce hypertrophy response (up to 50%) upon portal vein embolization in portal vein embolization[3]. Underlying liver disease might be the reason why ALPPS seems less safe and effective in HCC .
The aim of our proposed study is to validate the effectiveness of ALPPS in patients with HCC.
To address this issue, we propose to make use of the ALPPS registry to compare patients with HCC and liver fibrosis to all other patients undergoing ALPPS. We intend to personally contact all the respective centers that registered HCC patients in the ALPPS registry in order to complete potentially missing histopathological data of the currently available over 17 HCC patients in the registry and involve the largest contributors in the analysis. Primary endpoint for our proposed retrospective review is 30/90-day mortality. As secondary endpoints we plan to include postoperative complications categorized by Clavien-Dindo score and future liver remnant (FLR) increase. We will attempt to correlate the outcomes with the histopathological changes. The results of this proposed study may further characterize good candidates for the ALPPS procedure by improving patient selection and overall outcome.
Message from Erik Schadde: status: data collection, mostly in terms of histology. We are trying to collect histology samples from participating center to evaluate the impact of fibrosis, cirhhhosis, HCV and steatosis/NASH on whether ALPPS was sucessfull in 19 patients with HCC, varying degrees of fibrosis and cirrthosis in 2 patients, viral hepattis and steatohepatits.


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