MINI-ALPPS achieves adequate future liver remnant (FLR) hypertrophy to allow safe two stage liver resection

Background: Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) for patients with otherwise unresectable disease has generated controversy due to high morbidity and mortality. We present our series of patients with parenchymal transection limited to 30-40% (MINI -ALPPS). Methods: Patients who had MINI-ALPPS between April 2015 and April 2016 were included. In patients with colorectal liver metastases (CRC) the FLR was cleared with metastasectomies; all patients had the liver divided along the future line of transection to 30-40%. The Right portal vein was stapled and divided without extensive hilar dissection. In Stage1 there was minimal handling of right liver which was not mobilised and the middle hepatic vein was preserved, Data was collected prospectively looking specifically at hypertrophy of the FLR and morbidity and mortality. Results: There were 8 patients (Age 25-68). 1 patient with cholangiocarcinoma had portal vein embolisation, but then proceeded to MINI-ALPPS. All patients completed two stages with adequate FLR hypertrophy at a median of 30 days. There was no mortality. Median length of stay after Stage 1 and 2 were 9 and 9.6 days respectively. All patients had CT scan to assess FLR volume prior to Stage 2. Conclusion: A limited transection of 30-40% achieves adequate levels of hypertrophy in order to proceed to the second stage of the operation with low morbidity and no mortality. We feel it is worth pursuing this strategy for patients with otherwise inoperable disease.