Evolution of ALPPS: The Simpler, Safer and Effective One---TELPP = Evolution of ALPPS: The Simpler, Safer and Effective One---TELPP

다국어 초록 (Multilingual Abstract)

Aims: The characteristic of associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) carries high mortality and morbidity. There is room for improvement. We suggest Terminal Branches Portal Vein Embolization (TBPVE) as a way to compart the liver. As a result, only a single surgical operation is required.This method is termed Terminal branches portal vein Embolization Liver Partition Planned hepatectomy (TELPP).
Methods: Patients with unresectable primary or metastatic liver tumor were performed with TELPP. The procedure of TELPP was that in addition to PVE, embolization agent was infused to the terminal branches of portal vein of S5,S8 or S4. CT scan was taken one or two weeks later, and standard liver volume(SLV), FLR and FLR／SLV are calculated. Two weeks later when the FLR and liver function is appropriate, open or laparoscopic hepatectomy is performed.
Results: The study included 11patients including hepatocellular carcinoma: n =8, intrahepatic cholangiocarcinoma: n = 1, hilarcholangiocarcinoma: n =1, colorectal liver metastasis: n =1. After a waiting period of 14 days, the volume of theFLR had increased from 382mlto 578ml, representing a median volume increase of 51% (range =32.5%-86.7%). Of the 11patients with hepatectomy, right hemihepatectomy (n=2), extended right hemihepatectomy (n=5), right trisecmentectomy(2), extended left hemihepatectomy (n=1) and left trisecmentectomy(1). No patient died, and no serve perioperative morbidity occurred.
Conclusions: ALPPS and all modifications need two-stage operations with a high morbidity and mortality rate. It seems that TELPP is very promising. It has the merit of ALPPS as extraordinarily rapid increasement of FLRvolume, yet the morbidity and mortality is much lower, owing to the fact that unlike ALPPS, there is no two liver raw surfaces left behind in the abdominal cavity to produce bile leak, as only single surgical operation is required