ALPPS for hepatocarcinoma under cirrhosis: a feasible alternative to portal vein embolization

Abstract

Hepatocellular carcinoma (HCC) is one of the most common and malignant tumors.Preoperative portal vein embolization (PVE) is currently the most accepted treatment before major hepatic resection for HCC in patients with liver fibrosis or cirrhosis and associated insufficient future liver remnant (FLR). In the last decade, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique has been described to obtain an increase of volume regarding PVE and a decrease of drop out. The initial excessive morbidity and mortality of this technique have decreased drastically due to a better selection of patients, the learning curve and the use of less aggressive variations of the original technique in the first stage. For both techniques a complete preoperative assessment of the FLR is the most important issue and only patients with and adequate FLR should be resected. ALPPS could be a feasible technique in very selected patients with HCC and cirrhosis. As long as it is performed in an experienced center could be used as a first choice technique versus PVE or could be used as a rescue technique in case of PVE failure.

Sequential Portal Vein Embolization and Percutaneous Radiofrequency Ablation for Future Liver Remnant Growth: A Minimally Invasive Alternative to ALPPS Stage-1 in Treatment of Hepatocellular Carcinoma

“…To begin with, there was no control group, making a direct comparison of efficacy between PVE+RFA and PVE alone impossible. However, the FLR increase after PVE among cirrhosis patients has been reported to be between 24 and 38% during a median of 36 days ( 31 ), which is inferior to our results. Still, prospective, controlled trials are required to verify the efficacy of sequential PVE+RFA.…”

Oncological benefits of portal vein embolization for patients with hepatocellular carcinoma

“…The first step includes tumor enucleation of the FLR followed by PVE or PVL, while the second step involves major hepatectomy. [70][71][72] Associated liver partition and PVL for staged hepatectomy (ALPPS) is a novel operative procedure consisting of two steps:…”

“…(a) PVE or PVL and liver transection with or without tumor enucleation from the residual liver, and (b) major hepatectomy. [70][71][72] ALPPS technique has been described to obtain an increased volume of PVE and a decrease in dropout rates. [70][71][72] ALPPS could be a feasible technique only in selected patients with HCC and cirrhosis.…”

“…[70][71][72] ALPPS technique has been described to obtain an increased volume of PVE and a decrease in dropout rates. [70][71][72] ALPPS could be a feasible technique only in selected patients with HCC and cirrhosis. 71,72 The 3-and 5-year DFS and OS rates were 34.9%, and 25.0%, and 41.8%, and 40.7%, respectively (P = .267), and 60.2% and 46.8%, and 73.5%, and 64.1%, respectively (P = .234), in the ALPPS and PVE groups.…”

“…[70][71][72] ALPPS could be a feasible technique only in selected patients with HCC and cirrhosis. 71,72 The 3-and 5-year DFS and OS rates were 34.9%, and 25.0%, and 41.8%, and 40.7%, respectively (P = .267), and 60.2% and 46.8%, and 73.5%, and 64.1%, respectively (P = .234), in the ALPPS and PVE groups. Recently, several types of modified ALPPS procedure including laparoscopic partial ALPPS have been developed mainly to decrease morbidity and mortality.…”