Clinical Scorecard: Identifying Risk Factors for Wound Complications Following Staged Hepatectomy with Liver Partition and Portal Vein Ligation (ALPPS) in Comparison to Repeated Liver Resection: A Propensity Score Matched Study

At a Glance

Key Highlights

• ALPPS promotes accelerated future liver remnant growth but carries high morbidity and mortality risks including wound complications.
• Wound complications include surgical site infection (SSI), fascial dehiscence, and incisional hernia, with risk factors including impaired liver function and repeated surgeries.
• Propensity score matching was used to compare wound complication rates among ALPPS, repeated liver resection (RLR), and single liver resection (SLR) patients.

Guideline-Based Recommendations

Diagnosis

• Define wound complications as SSI, wound dehiscence, abdominal fascial dehiscence, or incisional hernia per CDC criteria.
• Use clinical and laboratory data pre- and post-surgery to assess risk factors including liver function and prior surgeries.

Management

• Consider ALPPS for patients with insufficient future liver remnant to enable curative resection.
• Monitor and manage wound complications proactively in patients undergoing ALPPS or repeated liver resections.

Monitoring & Follow-up

• Follow patients for at least 12 months postoperatively to detect wound complications.
• Assess wound healing status especially in patients with obesity (BMI ≥ 30 kg/m²) and impaired liver function.

Risks

• Recognize that repeated abdominal incisions and impaired liver function increase risk of wound complications.
• Understand that ALPPS involves repeated incisions in a short period, potentially increasing wound complication risk compared to repeated resections at longer intervals.

Patient & Prescribing Data

Adults undergoing major liver resections including ALPPS, repeated liver resections, and single liver resections for malignant liver tumors

ALPPS facilitates rapid liver regeneration but requires careful patient selection and monitoring due to high morbidity including wound complications.

Clinical Best Practices

• Use propensity score matching to balance confounding variables when comparing surgical outcomes.
• Employ reverse L-shaped incision (rL-incision) consistently for major liver resections to standardize surgical approach.
• Perform thorough preoperative assessment including liver function tests and history of previous abdominal surgeries to stratify wound complication risk.

References

• Surgical advancements in liver malignancies and ALPPS development
• CDC criteria for surgical site infection
• STROCSS 2021 reporting guidelines