RESUMEN
Since the inception of the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure, many centres have used this technique for patients who would otherwise be considered unresectable due to insufficient future liver remnant. In this report, we presented the case of a paediatric patient with recurrent hepatocellular carcinoma who underwent monosegment ALPPS (M-ALPPS) hepatectomy preserving segment 1 as the sole liver remnant using indocyanine green (ICG) as a fluorescence guide.
RESUMEN
BACKGROUND: The standard treatment for ampullary adenocarcinoma is pancreaticoduodenectomy. Identification of preoperative risk factors might help the clinician to select patients fit for resection and potentially decrease morbidity and mortality after PD. We conducted a cohort study to determine the preoperative factors related to 90-day severe morbidity and mortality after PD. METHODS: We conducted a retrospective cohort study in patients with a diagnosis of ampullary adenocarcinoma who underwent an open PD between January 2010 and December 2019 at our tertiary centre. RESULTS: Independent preoperative predictors of mortality were the albumin-bilirubin (ALBI) grade 3 (OR: 21.7; CI 95: 2.1-226.9; p=0.01) and the estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 (OR: 17.7; CI 95: 1.8-172.6; p=0.013). The eGFR <90 mL/min/1.73 m2 (OR = 6.6; CI 95: 1.9-23.4; p=0.003) and prothrombin time (OR = 1.5; CI 95; 1.1-2.1; p=0.005) were independent predictors for severe morbidity. CONCLUSION: These findings suggest that baseline renal function measured by the eGFR and liver function categorized with the ALBI grading are predictors of severe morbidity and mortality. Thus, they should be considered when selecting patients for PD or the use of neoadjuvant treatments. Further research is warranted.