Background: ALPPS leads to fast and effective liver hypertrophy. This enables the resection of extended tumors. Conventional ALPPS is associated with high morbidity and mortality. MILS reduces morbidity and the robot adds technical features that make complex procedures safe. Material and Methods: The MD-MILS was screened for patients who underwent rALPPS. Demographic and perioperative data were evaluated retrospectively. Ninety days postoperative morbidity was scored according to the CD classification. The findings were compared with the literature. Results: Since November 2021, five patients have been identified. The mean age and BMI of the patients were 50.0 years and 22.7 kg/m2. In four cases, patients suffered from colorectal liver metastases and, in one case, intrahepatic cholangiocarcinoma. Prior to the first operation, the mean liver volume of the residual left liver was 380.9 mL with a FLR-BWR of 0.677%. Prior to the second operation, the mean volume of the residual liver was 529.8 mL with a FLR-BWR of 0.947%. This was an increase of 41.9% of the residual liver volume. The first and second operations were carried out within 17.8 days. The mean time of the first and second operations was 341.2 min and 440.6 min. The mean hospital stay was 27.2 days. Histopathology showed the largest tumor size of 39 mm in diameter with a mean amount of 4.7 tumors. The mean tumor-free margin was 12.3 mm. One complication CD > 3a occurred. No patient died during the 90-day follow up. Conclusion: In the first German series, we demonstrated that rALPPS can be carried out safely with reduced morbidity and mortality in selected patients.
背景：联合肝脏离断和门静脉结扎二步肝切除术（ALPPS）能快速有效地诱导肝脏增生，从而实现对广泛肿瘤的切除。传统ALPPS存在较高的并发症发生率和死亡率。微创肝切除术（MILS）可降低并发症发生率，而机器人手术系统提供的技术特性使复杂手术操作更为安全。材料与方法：通过MD-MILS数据库筛选接受机器人辅助ALPPS（rALPPS）的患者，回顾性分析人口统计学资料及围手术期数据。术后90天并发症按Clavien-Dindo分级系统进行评估，并将研究结果与现有文献进行对比。结果：自2021年11月起，共纳入5例患者。患者平均年龄50.0岁，平均体重指数22.7 kg/m²。其中4例为结直肠癌肝转移，1例为肝内胆管癌。首次手术前残余左肝平均体积为380.9 mL，标准残肝体积比（FLR-BWR）为0.677%；二次手术前残肝平均体积增至529.8 mL，FLR-BWR达0.947%，残肝体积增长41.9%。两次手术平均间隔17.8天，首次与二次手术平均时长分别为341.2分钟和440.6分钟，平均住院时间27.2天。病理学检查显示最大肿瘤直径为39 mm，平均肿瘤数量4.7个，平均切缘宽度12.3 mm。1例患者出现Clavien-Dindo分级>3a的并发症。90天随访期间无死亡病例。结论：在德国首组病例系列中，我们证实对经过选择的患者实施rALPPS可安全开展，并能降低并发症发生率与死亡率。
肿瘤(癌症)患者之家