Associating Liver Partition and Portal Vein Ligation for Primary Hepatobiliary Malignancies and Non-Colorectal Liver Metastases

Abstract

Background and Aims: Associating liver partition and portal vein ligation for staged hepatectomy may increase the possibility of radical resection in the case of liver malignancy. concerns have been raised about the high morbidity and mortality associated with the procedure, particularly when applied for diagnoses other than colorectal liver metastases. the aim of this study was to analyze the initial experience with associating liver partition and portal vein ligation for staged hepatectomy in cases of non-colorectal liver metastases and primary hepatobiliary malignancies in scandinavia.Materials and Methods: A retrospective analysis of all associating liver partition and portal vein ligation for staged hepatectomy procedures performed at two swedish university hospitals for non-colorectal liver metastases and primary hepatobiliary malignancies was performed. the primary focus was on the safety of the procedure.Results and Conclusion: ten patients were included: four had hepatocellular cancer, three had intrahepatic cholangiocarcinoma, one had a Klatskin tumor, one had ocular melanoma metastasis, and one had a metastasis from a Wilms' tumor. All patients completed both operations, and the highest grade of complication (according to the clavien-dindo classification) was 3A, which was observed in one patient. no 90-day mortality was observed. radical resection (r0) was achieved in nine patients, while the resection was r2 in one patient. the low morbidity and mortality observed in this cohort compared with those of earlier reports on associating liver partition and portal vein ligation for staged hepatectomy for diagnoses other than colorectal liver metastases may be related to the selection of patients with limited comorbidity. in addition, procedures

Preoperative strategies to improve resectability for hepatocellular carcinoma: a systematic review and meta-analysis

“…2d). 18,19,21,22,24,28,45,55 ALPPS' absolute risk increase (ARI) was about 15% when compared with PVE/PVL and TACE + PVE as shown in Table 1.…”

“…1). [15][16][17][18][19][20][21][22][23][24] There were only 3 comparative studies ( Supplementary Table 1). 23,39,60 There were 10 studies encompassing sequential TACE + PVE (N = 252), 11 studies with PVE or PVL only (N = 456), 11 studies with ALPPS (N = 151), 8 studies with mixed strategies (N = 387), 4 studies with RE (N = 28), one study with PVE and hepatic vein embolization (N = 3), and one study of radiofrequency-assisted ALPPS (N = 10).…”

“…The pooled data of the meta-analysis demonstrated that mortality after liver resection was 0.065 (95% CI 0.043, 0.097; N = 1031). [15][16][17][18][19][20][21][22]24,[26][27][28][29][30]32,33,[36][37][38][39][40][41][43][44][45][46][47][48][49][50][51][55][56][57][58][59][60] When considering only the sequential TACE + PVE, the mortality risk was 0.05 (95% CI 0.029, 0.086; N = 327; Fig. 2a).…”

Asociación de Partición Hepática y Ligadura Portal para Hepatectomía por Etapas (ALPPS)

“…Sin embargo, existen otras indicaciones mucho menos frecuentes como metástasis de tumores de Wilms, ovario, cérvix uterino, estómago. GISTs y melanoma (Nadalin et al, 2014;Schadde et al, 2014a;Ratti et al;Rochet et al;Zhang et al, 2014;Hasselgren et al, 2015;Lang et al, 2015;Truant et al, 2015;Vivarelli et al, 2015;Buac et al;Björnsson et al, 2016a;Røsok et al, 2016); todo lo cual, debe estar en relación con la existencia de un hígado remanente menor de 25 % a 30 % (hígados sanos) y menor de 40 % (hígados colestásicos, esteatósicos, con fibrosis, o con cambios patológicos secundarios a quimioterapia (Nadalin et al; Ratti et al; Zhang et al; Buac et al).…”

“…Sin embargo, estas técnicas de oclusión portal, producen una hipertrofia tardía, que puede lograrse 4 a 8 semanas después; lo que influye en una progresión tumoral (Elias et al, 1999;de Graaf et al, 2009;Björnsson et al, 2016a).…”