ALPPS Technique Modification and Impact on Outcomes

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.