ALPPS in overcoming small remnant liver volume in alveolar echinococcosis

Abstract

Aim.To evaluate the possibilities and indications for ALPPS, immediate and long-term results of surgical treatment of alveolar echinococcosis including great vessels invasion in case of small remnant liver volume.Material and methods. There were 30 ALPPS procedures. Seven patients had small future liver remnant (FLR) — 24.5% (22.4—26.7%). Bile ducts repair with Roux-en-Y procedure for biliodigestive anastomosis during the first surgical stage was performed in 5 patients (71.4%). ALPPS combined with great vessels resection (portal vein or portal vein and left hepatic vein) was required in 4 patients (57.1%). RO-resections were carried out in all patients.Results.Mean duration of ALPPS stage I was 365 (330—415) min, intraoperative blood loss — 800 (700—1000) ml. Time of stage II was 85 (70—110) min, intraoperative blood loss — 200 (100—300) ml. The second stage of ALPPS was performed in 6—7 days (max 8 days) after preliminary assessment of FLR volume according to CT-volumetry, which was 570 (430—630) ml (37.9% (31.9—52.4%) in relation to FLR volume before the first stage of ALPPS. Augmentation of FLR volume was 200 (150—290) ml (60.9% (48.3—80.6%)). The daily increase of FLR volume was 29 (23—46) ml. Overall postoperative morbidity was 42.9% (complications grade I were noted in 2 patients (28.6%), grade IV — in 1 patient (14.3%). Incidence of post-hepatectomy liver failure grade A (ISGLS, 2011) after ALPPS stage II was 42.9% (n = 3). Bile leakage grade A (ISGLS, 2011) occurred in 28.6% of cases (n = 2). Mortality was absent. Postoperative hospital-stay after stage II was 22 (18—35) days. Maximum follow-up was 50 months. Long-term disease-free survival was 100%, median survival — 29 months.Conclusion.ALPPS technique is feasible, followed by desired increase of FLR volume and safe hepatectomy. The procedure leads to good immediate and long-term postoperative results in patients with alveolar echinococcosis and small FLR volume regard less invasion of afferent and/or efferent liver vessels.