ALPPS for Patients with Colorectal Liver Metastases: Effective Liver Hypertrophy, but Early Tumor Recurrence

Oldhafer, Karl J.; Donati, Marcello; Jenner, R.; Stang, Axel; Stavrou, Gregor A.

doi:10.1007/s00268-013-2401-2

Cited by 144 publications

(112 citation statements)

References 17 publications

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“…However, clinical as well as experimental data are controversial and need further investigation. While some authors described an earlier tumor recurrence in admittedly very small series, the meta-analysis by Moris et al [48] showed similar tumor recurrence rates for TSH and ALPPS [50]. However, since there is a great variability in indications and patient selection for TSH and ALPPS from center to center, it is most likely that comparability of data is limited.…”

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confidence: 99%

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Lang¹,

Baumgart²,

Mittler³

2018

Dig Surg

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Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has expanded the surgical armamentarium for patients with advanced and bilateral colorectal liver metastases. However, the enthusiasm that the medical fraternity had about ALPPS was hampered by a high mortality rate and early and frequent tumor recurrence. While surgical safety has improved, mainly due to technical refinements and a better patient selection, the oncological value in the face of early tumor recurrence remains unclear. The only randomized controlled trial on ALPPS versus two-stage hepatectomy (TSH) so far confirmed that ALPPS led to higher resectability with comparable perioperative complication rate, but oncological outcome was not measured. Robust data regarding long-term outcome are still missing. TSH and ALPPS might be complementary strategies for the resection of colorectal liver metatsases (CRLM) with ALPPS being reserved for patients with no other surgical option, that is, after failed portal vein embolization or those with an extremely small future liver remnant. In other words, ALPPS can be considered a supplementary tool and a last resort in the liver surgeon’s hand to offer resectability in otherwise nonresectable CRLM. In these individual cases, and always embedded into a multimodal treatment setting, ALPPS may offer a chance of complete tumor removal and prolonged survival and even a chance for cure.

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confidence: 99%

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Lang¹,

Baumgart²,

Mittler³

2018

Dig Surg

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“…8,9 Three methods to enlarge FLR are possible in this situation before ERH: (1) surgical right-sided portal vein ligation (PVL), 10,11 (2) portal vein embolization (PVE) as an interventional approach used by various centres [12][13][14] and (3) the surgical approach of "associating liver partition with PVL for staged hepatectomy". [15][16][17] However, as hypertrophy following PVE is necessary but highly variable, we retrospectively analyzed data from our patient cohort for differences in those with good hypertrophy (increase to .25% of the sFLR) and those with a less beneficial increase in size of sFLR.…”

Section: Introductionmentioning

confidence: 99%

Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization—the effect of collaterals on embolized liver volume

Zeile¹,

Bakal

Volkmer³

et al. 2016

The British Journal of Radiology

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Objective: The purpose of this retrospective study was to monitor hypertrophy of future liver remnant following portal vein embolization (PVE) before planned extended right hepatectomy. However, because individual responses to PVE are highly variable, our focus was to identify cofactors of successful hypertrophy. Methods: 28 patients with primary or secondary liver tumours, mean age 64.1 6 12.9 years, underwent PVE. Volumetric analysis of hypertrophy before and after PVE (median 39.0 6 15.7 days) was performed. The embolized liver segments were investigated for occurrence of reperfusion of their portal branches. Blood parameters before PVE were additionally investigated. Results: Patients were divided into responders (21/28) and non-responders (7/28) by post-PVE standardized future liver remnant being above or below 25%, respectively. No significant differences between the groups were found regarding biometric and volumetric parameters before PVE. In the entire group after PVE, the mean absolute increase of Segments 2 and 3 was 196.0 6 84.7 cm 3 and the median relative increase was 46.6 6 98.8%. The formation of left to right hepatic portoportal collaterals exhibited a negative correlation to successful hypertrophy (p 5 0.004) as well as low plasma total protein (p 5 0.019). Successful embolization of Segment IV showed only a trend to significance (p 5 0.098). Conclusion: Cofactors associated with a favourable outcome regarding hypertrophy were the absence of collaterals in the control CT scans and high plasma total protein. Advances in knowledge:Portoportal collaterals negatively influence hypertrophy after PVE. On the other hand, plasma total protein is a positive prognostic indicator on hypertrophy of the liver in our cohort.

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“…metastases. In fact, as shown by the ALPPS registry data, colorectal liver metastases currently represent the primary indication for ‘in-situ split' liver resection/ALPPS in our center and worldwide [14,15,19,20,21,22]. …”

Section: Discussionmentioning

confidence: 99%

‘In-Situ Split' Liver Resection/ALPPS - Historical Development and Current Practice

Hackl¹,

Lang²

2017

Visc Med

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Background: Liver tumors that are extensive, multifocal, or critically located frequently require advanced techniques of liver resection including ‘functional augmentation' of liver segments. Here we describe the invention and stepwise establishment of a new technique - termed ‘in-situ split' liver resection or ‘ALPPS' - enabling liver resection in certain situations. Methods: The development of the technique in the first and the subsequent 8 patients in the index center, and also the method's spread throughout Germany and the world were reviewed. Results: In 2007, in the first patient, the new technique was developed intraoperatively by necessity. Due to the convincing outcome, it was deliberately applied again several months later in another patient, and thereafter (sparsely) used for liver resection for various indications. Following oral communication, the method spread throughout Germany, and later - mainly following the publication of the initial multicentric German series - very quickly disseminated worldwide. Currently, it is used for a very (if not overly) broad spectrum of indications by many hepatobiliary surgery centers. Conclusion: In-situ split/ALPPS is a newly developed technique for liver resection, which was established for very specific situations. This method has created a hype, and is currently used rather generously by many centers worldwide.

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ALPPS for Patients with Colorectal Liver Metastases: Effective Liver Hypertrophy, but Early Tumor Recurrence

Abstract: The patient group operable only through ALPPS is at high risk for recurrence and early tumor progression. Still, this new method is the only chance for an oncological treatment strategy including a surgical approach and possibly better outcome.

Cited by 144 publications

References 17 publications

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy in the Treatment of Colorectal Liver Metastases: Current Scenario

Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization—the effect of collaterals on embolized liver volume

‘In-Situ Split' Liver Resection/ALPPS - Historical Development and Current Practice

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