Alpps: Past, Present and Future

Torres, Orlando Jorge Martins; Fernandes, Eduardo; Herman, Paulo

doi:10.1590/s0102-67202015000300001

Cited by 8 publications

(8 citation statements)

References 8 publications

(10 reference statements)

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“…The strict selection of patients enables some groups to perform ALPPS with low mortality [6] . According to Schadde et al, among 15 patients with HCC who underwent ALPPS, incomplete resection was not observed, disease-free survival at one year was 87%, Clavien-Dindo complications ≥IIIb were 25% (colorectal liver metastasis 21%, p > 0.05), and 90-day mortality was 12% [5] . During the transection, the anterior approach can result in minor intraoperative blood loss and the need for perioperative blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…The main indications for ALPPS are extensive bilobar colorectal liver metastases with a future liver remnant <25% [3] , [4] . According to the first international consensus meeting on ALPPS, the procedure is indicated in selected patients with HCC [5] . We present the case of a patient with HCC larger than 10 centimeters who underwent an ALPPS procedure.…”

Section: Introductionmentioning

confidence: 99%

The ALPPS procedure for hepatocellular carcinoma larger than 10 centimeters

Torres

Vasques

Silva

et al. 2016

International Journal of Surgery Case Reports

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“…On the contrary, ALPPS has been reported in HCC patients, particularly when there is vascular invasion. Torres et al[63] reported zero incomplete resection in HCC patients; a 1-year DFS of 87%, 90-d mortality of 12% and rate of high-grade complications (Clavien-Dindo complications IIIb or more) of 25%. Björnsson et al[64] reported no 90-d mortality in patients who underwent ALPPS for primary hepatobiliary malignancies (4 out of 10 patients had HCC).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of staged hepatectomies for liver malignancy

Albati

Korairi²,

Hasan

et al. 2019

WJH

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Liver malignancies are the fifth most common cause of death worldwide. Surgical intervention with curative intent is the treatment of choice for liver tumors as it provides long-term survival. However, only 20% of patients with metastatic liver lesions can be managed by curative liver resection. In most of the cases, hepatectomy is not feasible because of insufficient future liver remnant (FLR). Two-stage hepatectomy is advocated to achieve liver resection in a patient who is considered to not be a candidate for resection. Procedures of staged hepatectomy include conventional two-stage hepatectomy, portal vein embolization, and associating liver partition and portal vein ligation for a staged hepatectomy. Technical success is high for each of these procedures but variable between them. All the procedures have been reported as being effective in achieving a satisfactory FLR and completing the second-stage resection. Moreover, the overall survival and disease-free survival rates have improved significantly for patients who were otherwise considered nonresectable; yet, an increase in the morbidity and mortality rates has been observed. We suggest that this type of procedure should be carried out in high-flow centers and through a multidisciplinary approach. An experienced surgeon is key to the success of those interventions.

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“…While ALPPS has been shown to induce fast hypertrophy of the FLR, it still raises passionate discussion at HPB community regarding indications, morbidity and oncological outcomes. [19][20][21][22][23][24] Salvage ALPPS may be the least questionable indication for this procedure and is a potential rescue strategy when PVO fails to induce the necessary hypertrophy of the FLR.…”

Section: Discussionmentioning

confidence: 99%

ALPPS as a salvage procedure after insufficient future liver remnant hypertrophy following portal vein occlusion

Enne¹,

Schadde

Björnsson

et al. 2017

HPB

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“…ALPPS was developed in 2007 to induce liver hypertrophy in patients planned for extended liver resections with marginal FLR. A two-step operation, the initial data demonstrated it to be quite effective with rapid hypertrophy [15], however, it has not gained wide acceptance secondary to significant morbidity and mortality and the need for larger scale studies [19][20][21]. However, there are more recent reports of "mini-ALPPS" where the procedure is performed minimally invasively and with limited peripheral division of the parenchyma.…”

Section: Preoperative Considerationsmentioning

confidence: 99%

Surgical Resection in HCC

Labadie¹,

Sullivan²,

Park³

2018

Liver Cancer

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Hepatocellular carcinoma (HCC) is a deadly disease. Its incidence is rising worldwide without significant improvement in survival in spite of improving therapies. A wide array of treatment options for HCC exist and include surgery, catheter-based therapies, radiation and systemic therapy. These modalities are often used in combination for optimal management in a multidisciplinary approach. Surgical resection remains one of the only curative therapeutic options for HCC, although it is indicated in select patients with localized disease. Herein, we cover the role of surgical resection in the management of HCC, reviewing the perioperative and operative considerations, in addition to highlighting the advances in minimally invasive surgery and novel navigation technologies.

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Alpps: Past, Present and Future

Cited by 8 publications

References 8 publications

The ALPPS procedure for hepatocellular carcinoma larger than 10 centimeters

Outcomes of staged hepatectomies for liver malignancy

ALPPS as a salvage procedure after insufficient future liver remnant hypertrophy following portal vein occlusion

Surgical Resection in HCC

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