Risk Factors for Wound Complications After ALPPS vs Repeated Liver Resection

Overview

This propensity score matched study compared wound complication rates following ALPPS, repeated liver resection (RLR), and single liver resection (SLR). It identified key risk factors for surgical site infections and fascial dehiscence, highlighting the impact of repeated surgeries and patient comorbidities on postoperative wound healing.

Background

Liver surgery is critical for treating primary and secondary liver malignancies, but recurrence rates remain high, necessitating repeated resections. ALPPS is a staged hepatectomy technique designed to accelerate future liver remnant growth, allowing resection in otherwise unresectable cases. Despite its benefits, ALPPS carries a high risk of morbidity, including wound complications such as surgical site infections and fascial dehiscence. Understanding wound complication rates and associated risk factors after ALPPS compared to repeated liver resections is essential for optimizing patient outcomes.

Data Highlights

Propensity score matching was performed 1:1:1 based on age, gender, and surgical indication to minimize confounding. Wound complications included surgical site infection (SSI), wound dehiscence, fascial dehiscence, and incisional hernia. Subgroup analysis assessed the impact of obesity (BMI ≥ 30 kg/m²) on outcomes.

Key Findings

• Wound complications such as SSI, fascial dehiscence, and incisional hernia are common after major liver surgery including ALPPS and repeated resections.
• Repeated abdominal incisions and impaired liver function are significant risk factors for postoperative wound complications.
• ALPPS involves two surgeries in a short interval, raising concerns about increased wound complication risk compared to repeated resections performed over longer intervals.
• Propensity score matching allowed comparison of ALPPS, RLR, and SLR groups with balanced baseline characteristics.
• Obesity (BMI ≥ 30 kg/m²) was analyzed as a potential modifier of postoperative wound complication risk.
• Multivariate logistic regression was used to identify independent risk factors for wound complications after repeated liver surgeries.

Clinical Implications

Clinicians should recognize that patients undergoing ALPPS or repeated liver resections are at elevated risk for wound complications due to repeated incisions and potential impaired liver function. Careful preoperative assessment, optimization of liver function, and vigilant postoperative wound monitoring are essential. Consideration of patient factors such as obesity may further guide risk stratification and tailored perioperative management.

Conclusion

This study highlights the importance of identifying and managing risk factors for wound complications in patients undergoing staged or repeated liver resections. Understanding these risks can improve surgical planning and postoperative care to enhance patient outcomes.

References

1. Schadde et al. 2014 -- ALPPS: A Novel Approach to Liver Resection
2. Centers for Disease Control and Prevention (CDC) -- Surgical Site Infection Definitions