Associating liver partition and portal vein ligation for a patient with hepatocellular carcinoma with a background of hepatitis B related fibrotic liver

Chia, Nam-Hung; Lai, Eric C. H.; Lau, Wan Yee

doi:10.1016/j.ijscr.2014.11.008

Cited by 13 publications

(7 citation statements)

References 11 publications

(16 reference statements)

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“…Previous reports suggest that careful patient selection for ISLT is necessary to reduce the mortality [6,35,36]. The advantage of ISLT strategies is clearly seen in the high proliferative stimulus that induces hypertrophy of the FLRV at a rate that is unmatched by PVE [17,[37][38][39]. An inadequate increase in the FLRV after PVE is a challenging and limiting problem which represents an exclusion criteria for extended hepatic resection [2,3,34,40,41].…”

Section: Discussionmentioning

confidence: 99%

In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection

Lehwald

Vaghiri

Esch³

et al. 2020

BMC Surg

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Background: Right extended liver resection is frequently required to achieve tumor-free margins. Portal venous embolization (PVE) of the prospective resected hepatic segments for conditioning segments II/III does not always induce adequate hypertrophy in segments II and III (future liver remnant volume (FLRV)) for extended rightresection. Here, we present the technique of in situ split dissection along segments II/III plus portal disruption to segments IV-VIII (ISLT) as a salvage procedure to overcome inadequate gain of FLRV after PVE. Methods: In eight patients, FLRV was further pre-conditioned following failed PVE prior to hepatectomy (ISLTgroup). We compared FLRV changes in the ISLT group with patients receiving extended right hepatectomy following sufficient PVE (PVEres-group). Survival of the ISLT-group was compared to PVEres patients and PVE patients with insufficient FLRV gain or tumor progress who did not receive further surgery (PVEnores-group). Results: Patient characteristics and surgical outcome were comparable in both groups. The mean FLRV-to-bodyweight ratio in the ISLT group was smaller than in the PVEres-group pre-and post-PVE. One intraoperative mortality due to a coronary infarction was observed for an ISLT patient. ISLT was successfully completed in the remaining seven ISLT patients. Liver function and 2-year survival of~50% was comparable to patients with extended right hepatectomy after efficient PVE. Patients who received a PVE but who were not subsequently resected (PVEnores) demonstrated no survival beyond 4 months.

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Section: Discussionmentioning

confidence: 99%

In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection

Lehwald

Vaghiri

Esch³

et al. 2020

BMC Surg

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“…Commonly, insufficient regeneration is accompanied by chronic liver disease. Chia et al reported that patients with hepatitis B virus (HBV)-related cirrhosis require a longer time for regeneration before stage 2 [ 25 ]. Furthermore, neoadjuvant chemotherapy and chemotherapy have been reported to inhibit liver regeneration to some extent.…”

Section: Discussionmentioning

confidence: 99%

Associating liver partition and portal vein ligation for staged hepatectomy versus conventional two-stage hepatectomy: a systematic review and meta-analysis

Zhou

Lin

et al. 2017

World J Surg Onc

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BackgroundIt is generally accepted that an insufficient future liver remnant is a major limitation of large-scale hepatectomy for patients with primary hepatocellular carcinoma. Conventional two-stage hepatectomy (TSH) is commonly considered to accelerate future liver regeneration despite its low regeneration rate. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), which is characterized by a rapid regeneration, has brought new opportunities.MethodsRelevant studies were identified by searching the selected databases up to September 2017. Then, a meta-analysis of regeneration efficiency, complication rate, R0 resection ratio, and short-term outcomes was performed.ResultsTen studies, comprising 719 patients, were included. The overall analysis showed that ALPPS was associated with a larger hyperplastic volume and a shorter time interval (P < 0.00001) than TSH. ALPPS also exhibited a higher completion rate for second-stage operations (odds ratio, OR 9.50; P < 0.0001) and a slightly higher rate of R0 resection (OR 1.90; P = 0.11). Interestingly, there was no significant difference in 90-day mortality between the two treatments (OR 1.44; P = 0.35).ConclusionsThese results indicate that compared with TSH, ALPPS possesses a stronger regenerative ability and better facilitates second-stage operations. However, the safety, patient outcomes, and patient selection for ALPPS require further study.Electronic supplementary materialThe online version of this article (10.1186/s12957-017-1295-0) contains supplementary material, which is available to authorized users.

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“…The short-and long-term effects on biological behavior of tumor growth is still unclear. Although there is a clinical report suggesting that ALPPS is also feasible in liver fibrosis 28 , there is no solid data to support its use in liver fibrosis. The procedure still needs further clinical data, and more basic researches are urgently needed.…”

Section: Discussionmentioning

confidence: 99%

“…The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure is a new surgical strategy. It represents a modification of a two-stage hepatectomy in which complete parenchymal transection is associated with ligation of contralateral portal vein 7 8 . It produces a significant increase of the FLR in a much shorter time compared with PVL or PVE.…”

mentioning

confidence: 99%

A preliminary study of ALPPS procedure in a rat model

Shi

Yang

Zheng

et al. 2015

Sci Rep

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Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been reported to be a novel surgical technique that provides fast and effective growth of liver remnant. Despite occasional reports on animal studies, the mechanisms of rapid liver regeneration in ALPPS remains unclear. In the present study, we intend to develop a reproducible rat model to mimick ALPPS and to explore the underlying mechanisms. Rats assigned to the portal vein ligation (PVL), left lateral lobe (LLL) resection, transection and sham groups served as controls. Results indicated that the regeneration rate in the remnant liver after ALPPS was two times relative to PVL, whereas rats with transection alone showed minimal volume increase. The expression levels of Ki-67 and PCNA were about ten-fold higher after ALPPS compared with the transection and LLL resection groups, and four-fold higher compared with the PVL group. The levels of TNF-α, IL-6 and HGF in the regenerating liver remnant were about three-fold higher after ALPPS than the controls. There was a more significant activation of NF-κB p65, STAT3 and Yap after ALPPS, suggesting synergistic activation of the pathways by PVL and transection, which might play an important role in liver regeneration after ALPPS.

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Associating liver partition and portal vein ligation for a patient with hepatocellular carcinoma with a background of hepatitis B related fibrotic liver

Cited by 13 publications

References 11 publications

In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection

In situ split plus portal vein ligation (ISLT) – a salvage procedure following inefficient portal vein embolization to gain adequate future liver remnant volume prior to extended liver resection

Associating liver partition and portal vein ligation for staged hepatectomy versus conventional two-stage hepatectomy: a systematic review and meta-analysis

A preliminary study of ALPPS procedure in a rat model

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