Abstract
Twenty five percent of total liver volume (TLV) is considered as the ideal functional liver remnant (FLR) in major liver resections. In patients with macro-vesicular steatosis, early cirrhosis, and post-neoadjuvant chemotherapy (NACT), hepatocellular injury is common. In such instances, up to 40% of FLR may be required. So in cases of marginal FLR, pre-operative portal vein (PV) embolization or two-stage hepatectomy with PV occlusion is used. Both of which take up to 14 weeks between stages and 30% of patients fail to reach the second resection either due to inadequate FLR growth or disease progression. Associated liver partition and portal vein ligation (ALPPS) procedure has become the gold standard for those cases. A 57-year-old male presented with rectosigmoid growth + multiple right liver and segment 4B metastases. Post-NACT MRI showed interval progression of lesions. Preoperative CT (computed tomography) volumetric scan showed a FLR/TLV (future liver remnant/total liver volume) of 22%. Since patient received 10 cycles of NACT, ALPPS procedure was planned ahead of direct liver resection. Robotic ALPPS stage 1 sparing left lateral segment and 4A + anterior resection was done. We transected the parenchyma between the FLR and the diseased part of the liver with concomitant right portal vein ligation done robotically. CT abdomen done on POD7 showed hypertrophied left lateral segment. Second stage was performed on the eighth post-operative day with FLR/TLV increasing to 37%. Robotic ALPPS procedure for stage one is a safe and feasible technique in experienced centers with advanced robotic skills.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cai Y-L, Song P-P, Tang W, Cheng N-S (2016) An updated systematic review of the evolution of ALPPS and evaluation of its advantages and disadvantages in accordance with current evidence. Hashimoto. DA, ed. Medicine (Baltimore) 95(24):e3941. https://doi.org/10.1097/MD.0000000000003941
Abulkhir A, Limongelli P, Healey AJ, Damrah O, Tait P, Jackson J, Habib N, Jiao LR (2008) Preoperative portal vein embolization for major liver resection: a meta-analysis. Ann Surg 247(1):49–57. https://doi.org/10.1097/SLA.0b013e31815f6e5b
Solomonov E, Nesher E, Aizner S, Mor E. Robotic ALPPS: major liver surgery may be performed safely through a minimally invasive approach. a presentation of five cases. HPB, Volume 18 , e693–e694
Zhang GQ, Zhang ZW, Lau WY, Chen XPALPPS (2014) A new strategy to increase resectability in liver surgery. Int J Surg 12(5):437–441. https://doi.org/10.1016/j.ijsu.2014.03.009
Adam R, Akpinar E, Johann M, Kunstlinger F, Majno P, Bismuth H (1997) Place of cryosurgery in the treatment of malignant liver tumors. Ann Surg 225(1):39–38
Wang ZJ, Wang MQ, Duan F, Song P, Liu FY, Chang ZF, Wang Y, Yan JY, Li K (2013) Transcatheter arterial chemoembolization followed by immediate radiofrequency ablation for large solitary hepatocellularcarcinomas. World J Gastroenterol 19(26):4192–4199. https://doi.org/10.3748/wjg.v19.i26.4192
Andres A, Toso C, Moldovan B, Schiffer E, Rubbia- Brandt L, Terraz S, Klopfenstein CE, Morel P, Majno P, Mentha G (2011) Complications of elective liver resections in a center with low mortality: a simple score to predict morbidity. Arch Surg 146(11):1246–1252. https://doi.org/10.1001/archsurg.2011.175
Turchetti G, Palla I, Pierotti F, Cuschieri A (2012) Economic evaluation of da Vinci-assisted robotic surgery: a systematic review. Surg Endosc 26(3):598–606. https://doi.org/10.1007/s00464-011-1936-2
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Krishnamurthy, J., Naragund, A.V. & Mahadevappa, B. First Ever Robotic Stage One ALPPS Procedure in India: for Colorectal Liver Metastases. Indian J Surg 80, 269–271 (2018). https://doi.org/10.1007/s12262-017-1713-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-017-1713-0