Minimally Invasive ALPPS Procedure: A Review of Feasibility and Short-Term Outcomes

SIMPLE SUMMARY: Associated liver partition with portal vein ligation for staged hepatectomy (ALPPS) represents a recent and promising strategy to perform extensive hepatic resection and limit the risk of post-operative liver failure. Significant morbidity and mortality rates in its pioneering stage has limited acceptance of this treatment. The aim of this review is to evaluate the feasibility, safety, and clinical outcomes of this strategy following application of laparoscopic approach and technical modifications. An evaluation of the data has highlighted that a mini-invasive approach, a less invasive technique in first stage and a better selection of patients could account for potentially better results after ALPPS procedure in terms of blood loss, morbidity, and mortality rate in comparison with outcomes of open series. ABSTRACT: Background: Associated liver partition with portal vein ligation for staged hepatectomy (ALPPS) represents a recent strategy to improve resectability of extensive hepatic malignancies. Recent surgical advances, such as the application of technical variants and use of a mini-invasive approach (MI-ALPPS), have been proposed to improve clinical outcomes in terms of morbidity and mortality. Methods: A total of 119 MI-ALPPS cases from 6 series were identified and discussed to evaluate the feasibility of the procedure and short-term clinical outcomes. Results: Hepatocellular carcinoma were widely the most common indication for MI-ALPPS. The median estimated blood loss was 260 mL during Stage 1 and 1625 mL in Stage 2. The median length of the procedures was 230 min in Stage 1 and 184 in Stage 2. The median increase ratio of future liver remnant volume was 87.8%. The median major morbidity was 8.14% in Stage 1 and 23.39 in Stage 2. The mortality rate was 0.6%. Conclusions: MI-ALPPS appears to be a feasible and safe procedure, with potentially better short-term outcomes in terms of blood loss, morbidity, and mortality rate if compared with those of open series.