Speciális májműtét (Associating Liver Partition and Portal vein ligation for Staged hepatectomy, ALPPS) morbiditásának csökkentése átértékelt betegkiválasztási elvek és műtéttechnikai módosítás révén

Translated title of the contribution: Decreasing morbidity after Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) with technical modification and patient selection

Hahn Oszkár, Bárdos Dávid, P. Kupcsulik, Szijártó Attila, Fülöp András, Kokas Bálint, Pekli Damján, Zsirka Klein Attila, Dudás Ibolyka, Pajor Péter, Harsányi László

Research output: Contribution to journalReview article

Abstract

Introduction: Resecability of liver tumors is exclusively depending on the future liver remnant (FLR). The remnant can be hypertrophised using portal vein occlusion techniques. The latest hypertrophising method is Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS), which provides the most significant induced hypertrophy in the shortest time. Morbidity and mortality of this procedure were initially unacceptably high. Aim: Reducing complications by better patient selection and modified surgical technique. Method: The First Department of Surgery, Semmelweis University, Budapest, prefers the 'no touch' technique, instead of 'complete mobilization'. For optimizing patient selection, an international registry (including our patients' data) was established. In addition to the surgical, we collected demographic, disease, liver function, histology, morbidity (Clavien-Dindo) and mortality parameters. Volume and function measurements were performed by using CT-volumetry and 99mtechnecium-mebrofenin SPECT/CT. Data were analyzed by multivariate analysis (significance: p<0.05). Results: We performed 20 ALPPS procedures from 2012 to 2018. The relative volume increment and resectability in our department and among the 320 registry patients were 96% vs. 86% and 95% vs. 98%. Using 'no touch' technique, the Clavien-Dindo III-IV morbidity and mortality rates were significantly lower (22%-0%) than with 'complete mobilization' (63%-36%) (p<0.05). Based on the multivariate analysis of the registry patients, age over 60 years, liver macrosteatosis, non-colorectal liver tumor, >300 minutes operation time, >2 units of red blood cell transfusion, or insufficient FLR function before stage 2 were identified as independent factors influencing mortality (p<0.05). Conclusion: Mortality and morbidity of ALPPS can be reduced by proper patient selection and 'no touch' surgical technique.

Original languageHungarian
Pages (from-to)1260-1269
Number of pages10
JournalOrvosi hetilap
Volume160
Issue number32
DOIs
Publication statusPublished - Jan 1 2019

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Hepatectomy
Portal Vein
Patient Selection
Ligation
Morbidity
Mortality
Liver
Touch
Erythrocyte Transfusion
Hypertrophy
Registries
Liver Diseases
Histology
Multivariate Analysis
Demography
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Speciális májműtét (Associating Liver Partition and Portal vein ligation for Staged hepatectomy, ALPPS) morbiditásának csökkentése átértékelt betegkiválasztási elvek és műtéttechnikai módosítás révén. / Oszkár, Hahn; Dávid, Bárdos; Kupcsulik, P.; Attila, Szijártó; András, Fülöp; Bálint, Kokas; Damján, Pekli; Attila, Zsirka Klein; Ibolyka, Dudás; Péter, Pajor; László, Harsányi.

In: Orvosi hetilap, Vol. 160, No. 32, 01.01.2019, p. 1260-1269.

Research output: Contribution to journalReview article

Oszkár, Hahn ; Dávid, Bárdos ; Kupcsulik, P. ; Attila, Szijártó ; András, Fülöp ; Bálint, Kokas ; Damján, Pekli ; Attila, Zsirka Klein ; Ibolyka, Dudás ; Péter, Pajor ; László, Harsányi. / Speciális májműtét (Associating Liver Partition and Portal vein ligation for Staged hepatectomy, ALPPS) morbiditásának csökkentése átértékelt betegkiválasztási elvek és műtéttechnikai módosítás révén. In: Orvosi hetilap. 2019 ; Vol. 160, No. 32. pp. 1260-1269.
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title = "Speci{\'a}lis m{\'a}jműt{\'e}t (Associating Liver Partition and Portal vein ligation for Staged hepatectomy, ALPPS) morbidit{\'a}s{\'a}nak cs{\"o}kkent{\'e}se {\'a}t{\'e}rt{\'e}kelt betegkiv{\'a}laszt{\'a}si elvek {\'e}s műt{\'e}ttechnikai m{\'o}dos{\'i}t{\'a}s r{\'e}v{\'e}n",
abstract = "Introduction: Resecability of liver tumors is exclusively depending on the future liver remnant (FLR). The remnant can be hypertrophised using portal vein occlusion techniques. The latest hypertrophising method is Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS), which provides the most significant induced hypertrophy in the shortest time. Morbidity and mortality of this procedure were initially unacceptably high. Aim: Reducing complications by better patient selection and modified surgical technique. Method: The First Department of Surgery, Semmelweis University, Budapest, prefers the 'no touch' technique, instead of 'complete mobilization'. For optimizing patient selection, an international registry (including our patients' data) was established. In addition to the surgical, we collected demographic, disease, liver function, histology, morbidity (Clavien-Dindo) and mortality parameters. Volume and function measurements were performed by using CT-volumetry and 99mtechnecium-mebrofenin SPECT/CT. Data were analyzed by multivariate analysis (significance: p<0.05). Results: We performed 20 ALPPS procedures from 2012 to 2018. The relative volume increment and resectability in our department and among the 320 registry patients were 96{\%} vs. 86{\%} and 95{\%} vs. 98{\%}. Using 'no touch' technique, the Clavien-Dindo III-IV morbidity and mortality rates were significantly lower (22{\%}-0{\%}) than with 'complete mobilization' (63{\%}-36{\%}) (p<0.05). Based on the multivariate analysis of the registry patients, age over 60 years, liver macrosteatosis, non-colorectal liver tumor, >300 minutes operation time, >2 units of red blood cell transfusion, or insufficient FLR function before stage 2 were identified as independent factors influencing mortality (p<0.05). Conclusion: Mortality and morbidity of ALPPS can be reduced by proper patient selection and 'no touch' surgical technique.",
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year = "2019",
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language = "Hungarian",
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TY - JOUR

T1 - Speciális májműtét (Associating Liver Partition and Portal vein ligation for Staged hepatectomy, ALPPS) morbiditásának csökkentése átértékelt betegkiválasztási elvek és műtéttechnikai módosítás révén

AU - Oszkár, Hahn

AU - Dávid, Bárdos

AU - Kupcsulik, P.

AU - Attila, Szijártó

AU - András, Fülöp

AU - Bálint, Kokas

AU - Damján, Pekli

AU - Attila, Zsirka Klein

AU - Ibolyka, Dudás

AU - Péter, Pajor

AU - László, Harsányi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Resecability of liver tumors is exclusively depending on the future liver remnant (FLR). The remnant can be hypertrophised using portal vein occlusion techniques. The latest hypertrophising method is Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS), which provides the most significant induced hypertrophy in the shortest time. Morbidity and mortality of this procedure were initially unacceptably high. Aim: Reducing complications by better patient selection and modified surgical technique. Method: The First Department of Surgery, Semmelweis University, Budapest, prefers the 'no touch' technique, instead of 'complete mobilization'. For optimizing patient selection, an international registry (including our patients' data) was established. In addition to the surgical, we collected demographic, disease, liver function, histology, morbidity (Clavien-Dindo) and mortality parameters. Volume and function measurements were performed by using CT-volumetry and 99mtechnecium-mebrofenin SPECT/CT. Data were analyzed by multivariate analysis (significance: p<0.05). Results: We performed 20 ALPPS procedures from 2012 to 2018. The relative volume increment and resectability in our department and among the 320 registry patients were 96% vs. 86% and 95% vs. 98%. Using 'no touch' technique, the Clavien-Dindo III-IV morbidity and mortality rates were significantly lower (22%-0%) than with 'complete mobilization' (63%-36%) (p<0.05). Based on the multivariate analysis of the registry patients, age over 60 years, liver macrosteatosis, non-colorectal liver tumor, >300 minutes operation time, >2 units of red blood cell transfusion, or insufficient FLR function before stage 2 were identified as independent factors influencing mortality (p<0.05). Conclusion: Mortality and morbidity of ALPPS can be reduced by proper patient selection and 'no touch' surgical technique.

AB - Introduction: Resecability of liver tumors is exclusively depending on the future liver remnant (FLR). The remnant can be hypertrophised using portal vein occlusion techniques. The latest hypertrophising method is Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS), which provides the most significant induced hypertrophy in the shortest time. Morbidity and mortality of this procedure were initially unacceptably high. Aim: Reducing complications by better patient selection and modified surgical technique. Method: The First Department of Surgery, Semmelweis University, Budapest, prefers the 'no touch' technique, instead of 'complete mobilization'. For optimizing patient selection, an international registry (including our patients' data) was established. In addition to the surgical, we collected demographic, disease, liver function, histology, morbidity (Clavien-Dindo) and mortality parameters. Volume and function measurements were performed by using CT-volumetry and 99mtechnecium-mebrofenin SPECT/CT. Data were analyzed by multivariate analysis (significance: p<0.05). Results: We performed 20 ALPPS procedures from 2012 to 2018. The relative volume increment and resectability in our department and among the 320 registry patients were 96% vs. 86% and 95% vs. 98%. Using 'no touch' technique, the Clavien-Dindo III-IV morbidity and mortality rates were significantly lower (22%-0%) than with 'complete mobilization' (63%-36%) (p<0.05). Based on the multivariate analysis of the registry patients, age over 60 years, liver macrosteatosis, non-colorectal liver tumor, >300 minutes operation time, >2 units of red blood cell transfusion, or insufficient FLR function before stage 2 were identified as independent factors influencing mortality (p<0.05). Conclusion: Mortality and morbidity of ALPPS can be reduced by proper patient selection and 'no touch' surgical technique.

KW - ALPPS

KW - Mortality

KW - Patient selection

KW - Surgical technique

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U2 - 10.1556/650.2019.31440

DO - 10.1556/650.2019.31440

M3 - Review article

C2 - 31387372

AN - SCOPUS:85070539084

VL - 160

SP - 1260

EP - 1269

JO - Orvosi Hetilap

JF - Orvosi Hetilap

SN - 0030-6002

IS - 32

ER -