Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS): Tips and Tricks

Alvarez, Fernando A.; Ardiles, Victoria; Clariá, Rodrigo Sanchez; Pekolj, Juan; Santibañés, Eduardo de

doi:10.1007/s11605-012-2092-2

Cited by 174 publications

(184 citation statements)

References 19 publications

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“…10 In the present series, we again report no deaths within 90 days in 32 patients, which to our knowledge makes this study the largest single-centre cohort with no perioperative mortality. 4 The largest available studies reporting on short-term outcomes of ALPPS are analyses of the International ALPPS Registry, with a published 90-day mortality of 9% and a severe complication (Clavien-Dindo ≥ IIIb) rate of 27%. 8,9 This morbidity and mortality is further attenuated in patients with CRLM and in those older than 60 years.…”

Section: Discussionmentioning

confidence: 99%

“…The second stage follows with removal of the deportalized part of the liver after rapid hypertrophy of the FLR. 4 The mechanism behind the accelerated hypertrophy in ALPPS is yet to be fully understood. Schlegel and colleagues 5 described an elegant rodent study suggesting that the rapid hypertrophy of liver parenchyma may be associated with a systemic increase of circulating factors released as part of an inflammatory reaction to the parenchymal split in conjunction with portal vein ligation (PVL) and increased blood flow to the FLR.…”

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Optimizing associated liver partition and portal vein ligation for staged hepatectomy outcomes: Surgical experience or appropriate patient selection?

Hasan

Tun-Abraham

Wanis

et al. 2017

CJS

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Background: Early reports of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) outcomes have been suboptimal. The literature has confirmed that learning curves influence surgical outcomes. We have 54 months of continuous experience performing ALPPS with strict selection criteria. This study aimed to evaluate the impact of the learning curve on ALPPS outcomes. Methods:We retrospectively compared patients who underwent ALPPS between April 2012 and March 2016. Patients were grouped into 2 24-month (early and late) periods. All candidates had a high tumour load requiring staged hepatectomy after chemotherapy response, a predicted future liver remnant (FLR) less than 30% and good performance status. Results:Thirty-three patients underwent ALPPS during the study period: 16 in the early group (median age 65 yr, mean body mass index [BMI] 27) and 17 in the late group (median age 60 yr, mean BMI 25). Bilobar disease was comparable in both groups (94% v. 88%, p > 0.99). Duration of surgery was not statistically different. Intraoperative blood loss and need for transfusion were significantly lower in the late group (200 ± 109 mL v. 100 ± 43 mL, p < 0.05). The late group had a higher proportion of monosegment ALPPS (4:1). There were no deaths within 90 days in either cohort. Rates of postoperative complications were not statistically significant between groups. The R0 resection rate was similar. The entire 1-year disease-free and overall survival were 52% and 84%, respectively. Conclusion:Excellent results can be obtained in innovative complex surgery with careful patient selection and good technical skills. Additionally, the learning curve brought confidence to perform more complex procedures while maintaining good outcomes.Contexte : Les premiers résultats sur l'association de la partition hépatique et de la ligature portale pour l'hépatectomie en 2 temps (ALPPS) sont sous-optimaux. La littérature a confirmé que les courbes d'apprentissage influencent les résultats des interventions chirurgicales. Notre étude reposait sur 54 mois consécutifs d'utilisation de la technique ALPPS selon des critères de sélection rigoureux. Elle visait à évaluer l'effet de la courbe d'apprentissage sur les résultats liés à l'ALPPS.Méthodes : Nous avons procédé à une comparaison rétrospective des patients traités par l'ALPPS entre avril 2012 et mars 2016. Nous avons divisé les patients en 2 groupes de 24 mois (précoce et tardif). Tous les candidats avaient une charge tumorale élevée nécessitant une hépatectomie en 2 temps après une réponse à la chimiothérapie, un volume estimé de futur foie résiduel (FFR) inférieur à 30 % et un indice fonctionnel favorable. Résultats :Trente-trois patients ont été traités par l'ALPPS pendant la période de l'étude : 16 dans le groupe précoce (âge médian 65 ans, indice de masse corporelle [IMC] moyen 27) et 17 dans le groupe tardif (âge médian 60 ans, IMC moyen 25). Le taux de maladie bilobaire était comparable entre les 2 groupes (94 % c. 88 %, p > 0,99). La durée de la chirurgie...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Optimizing associated liver partition and portal vein ligation for staged hepatectomy outcomes: Surgical experience or appropriate patient selection?

Hasan

Tun-Abraham

Wanis

et al. 2017

CJS

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“…At the same time, Schadde et al reported that the mortality were 11% (CI=8%-16%) and 44% (CI=38-50) respectively with complications grade IIIa or higher. On the contrary, Alvarez et al obtained 0% mortalities under modifications in highly selected patients, and the morbidity was decreased to 36% by Hernandez-Alejandro et al 4,22,23 Many surgeons payed special attention to the tumor recurrence and overall survival. Schadde et al compared 48 ALPPS cases with 83 conventional-staged hepatectomies cases, and found that the tumor recurrence at 1 year was 54% versus 52% for ALPPS and PVE/PVL, respectively (p=0.7).…”

Section: The Safety and Short-term Outcomes Of Alppsmentioning

confidence: 99%

ALPPS readdresses the management of advanced liver tumors

Huang

Xiao²,

Jun

et al. 2017

Int Surg J

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Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been developed to induce rapid liver hypertrophy of the future liver remnant (FLR) prior to hepatectomy in primarily non-resectable or marginally resectable liver tumors. In recent years, this novel strategy has aroused interests of many liver surgeons. Its indications have been broadened gradually with more and more reported cases. Modified ALPPS is also developed to reduce morbidity and mortality. The authors searched Medline and PubMed to identify related articles published in English, using terms: “ALPPS, associating liver partition and portal vein ligation for staged hepatectomy, in situ split, in situ splitting, liver partition”. The authors summarized and analysed the superiority, indications, modifications, safety, mechanisms of regeneration of ALPPS. ALPPS was more effective than traditional portal vein embolization (PVE) or portal vein ligation (PVL). ALPPS obtained 80% volume increase of future liver remnant (FLR ) within 7 days in contrast to 10%-46% within 2 to 8 weeks by PVE or PVL. ALPPS opens a chapter in the history of liver surgery and readdresses the management of advanced primary and metastatic liver tumors. The high morbidity and mortality associated with ALPPS could be decreased remarkably if we carefully select patients and carry out the operation with experienced surgeons. In addition, the safety, mechanisms and oncological outcome of ALPPS are still not clear, which need further research and randomized controlled trials.

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“…The pathologies that ALPPS is commonly used to treat include colorectal liver metastases, hilar cholangiocarcinoma, and HCC. Contraindications for ALPPS include unresectable liver metastases in the FLR, unresectable extrahepatic metastases, severe portal hypertension, high anesthetic risks, and a poor condition prior to major surgery (53).…”

Section: Associating Liver Partition and Pvl For Staged Hepatectomy (mentioning

confidence: 99%

Recent advances in surgical treatment of hepatocellular carcinoma

Song

2015

DD&T

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Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS): Tips and Tricks

Abstract: The presented technique was feasible and safe in the hands of experienced hepatobiliary surgeons, with satisfactory short-term results. It induces rapid liver hypertrophy and at the same time it offers the possibility of cure to patients previously declared unresectable.

Cited by 174 publications

References 19 publications

Optimizing associated liver partition and portal vein ligation for staged hepatectomy outcomes: Surgical experience or appropriate patient selection?

Optimizing associated liver partition and portal vein ligation for staged hepatectomy outcomes: Surgical experience or appropriate patient selection?

ALPPS readdresses the management of advanced liver tumors

Recent advances in surgical treatment of hepatocellular carcinoma

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