ALPPS: Challenging the concept of unresectability – A systematic review

Bertens, Kimberly A.; Hawel, Jeffrey; Lung, Kalvin; Buac, Suzana; Pineda-Solís, Karen; Hernandez‐Alejandro, Roberto

doi:10.1016/j.ijsu.2014.12.008

Cited by 65 publications

(72 citation statements)

References 88 publications

(96 reference statements)

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“…To achieve total tumor clearance in metastatic CRC, all strategies to improve resectability, i.e. portal vein embolization with hepatic hypertrophy on the contralateral side or the ‘associating liver partition and portal vein ligation' technique, may be utilized as individually adjusted treatment concepts [47,48,49,50,51,52,53,54]. …”

Section: Treatment Strategies In Advanced Stages Of Colorectal Cancermentioning

confidence: 99%

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

et al. 2016

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Background: Although colorectal surgery is long established as the mainstay treatment for colon cancer, certain topics regarding technical fine-tuning to increase postsurgical recurrence-free survival have remained a matter of debate throughout the past years. These include complete mesocolic excision (CME), treatment strategies for metastatic disease, significance of hyperthermic intraperitoneal chemotherapy (HIPEC), and surgical techniques for the treatment of colorectal cancer recurrence. In addition, new surgical techniques have been introduced in oncologic colorectal surgery, and their potential to provide sufficiently radical resection has yet to be proven. Methods: A structured review of the literature was performed to identify the current state of the art with regard to the mentioned key issues in colorectal surgery. Results: This article provides a comprehensive review of the current literature addressing the above-mentioned current challenges in colorectal surgery. The focus lies on the impact of CME and, in relation to this, on lymph node dissection, as well as on treatment of metastatic disease including peritoneal spread, and finally on the treatment of recurrent disease. Conclusion: Uniformly, the current literature reveals that surgery aiming at complete malignancy elimination within multimodal treatment approaches represents the fundamental quantum leap for the achievement of long-term tumor-free survival.

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Section: Treatment Strategies In Advanced Stages Of Colorectal Cancermentioning

confidence: 99%

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

et al. 2016

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“…However, concerns have been raised regarding the small liver remnants and the development of postoperative complications in these patients (2). Portal vein embolization (7) and portal vein ligation (8,9) are two conventional techniques, which are widely used prior to liver resection to maintain sufficient liver volumes following surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the long surgery duration of ~380 min during the first stage of ALPPS, along with the adverse effects of anesthesia and surgical stress on renal function possibly increased the risk and contributed to the development of acute kidney injury. Of patients undergoing the ALPPS procedure, 70% of cases presented liver metastasis from colorectal cancer, ~17% of patients presented primary liver cancer (2,10,11), and a small number of patients had liver cancer secondary to hepatitis-induced cirrhosis. The latter group of patients are more likely to suffer with viral nephropathy and are at a high risk of postoperative acute kidney injury.…”

Section: Discussionmentioning

confidence: 99%

“…Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel strategy for liver resection that was originally established in 2007 by the German surgeon Hans Schlitt (1,2), and was first reported in 2012 by Schnitzbauer et al (3). The original method utilizing laparotomy surgery has been improved by a completely laparoscopic surgery (4).…”

Section: Introductionmentioning

confidence: 99%

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Acute kidney injury following the first stage of the ALPPS procedure: A case report

2018

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Abstract. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel approach for performing liver resection, and the number of clinical applications of this technique has rapidly increased within recent years. ALPPS is important in patients who have insufficient residual liver volume and cannot undergo radical hepatic resection. The most common postoperative complications of ALPPS include biliary fistula and infection. To date, postoperative acute kidney injury following ALPPS has not been reported. The current study reports the case of a 63-year-old patient with hepatitis B-induced cirrhosis who underwent the first stage of ALPPS without completion of the second step. The patient developed postoperative acute kidney injury following ALPPS. The present case study suggests that the use of ALPPS in patients at risk of chronic renal damage should be approached with caution in order to avoid postoperative acute kidney injury. Furthermore, improvements in surgical techniques and skills of the surgeons performing the procedure are required to reduce the surgery duration and improve patient outcomes.

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“…In order to increase the FLR size prior to surgical resection, a number of techniques have been implemented by clinicians. This has resulted in an increase in candidates for hepatic resection (5) and a reduced risk of postoperative liver failure after major hepatectomy (6).…”

Section: Introductionmentioning

confidence: 99%

A totally laparoscopic associating liver partition and portal vein ligation for staged hepatectomy assisted with radiofrequency (radiofrequency assisted liver partition with portal vein ligation) for staged liver resection

Jiao¹,

Hakim²,

Gall³

et al. 2016

Hepatobiliary Surg. Nutr.

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In order to induce liver hypertrophy to enable liver resection in patients with a small future liver remnant (FLR), various methods have been proposed in addition to portal vein embolisation (PVE). Most recently, the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique has gained significant international interest. This technique is limited by the high morbidity associated with an in situ liver splitting and the patient undergoing two open operations. We present the case of a variant ALPPS technique performed entirely laparoscopically with no major morbidity or mortality. An increased liver volume of 57.9% was seen after 14 days. This technique is feasible to perform and compares favourably to other ALPPS methods whilst gaining the advantages of laparoscopic surgery.Keywords: Radiofrequency assisted liver partition with portal vein ligation (RALPP); associating liver partition and portal vein ligation for staged hepatectomy (ALPPS); liver resection; two-stage; portal vein ligation; radiofrequency ablation

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ALPPS: Challenging the concept of unresectability – A systematic review

Abstract: A consensus on the indications and contraindications for ALPPS and a standardized operative protocol are needed.

Cited by 65 publications

References 88 publications

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

Acute kidney injury following the first stage of the ALPPS procedure: A case report

A totally laparoscopic associating liver partition and portal vein ligation for staged hepatectomy assisted with radiofrequency (radiofrequency assisted liver partition with portal vein ligation) for staged liver resection

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