Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Offers High Oncological Feasibility With Adequate Patient Safety

Alvarez, Fernando A.; Ardiles, Victoria; Santibañes, Martín de; Pekolj, Juan; Santibañés, Eduardo de

doi:10.1097/sla.0000000000001046

Cited by 143 publications

(124 citation statements)

References 41 publications

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“…This first presentation of ALPPS attracted tremendous international interest and hepato-pancreato-biliary (HPB) groups from all over the world began to work in the field of ALPPS. Shortly thereafter, further reports confirmed the initial promising results and, in addition, it could be shown that ALPPS was effective even after the failure of PVE [20-26]. In an early retrospective analysis at 4 specialized HPB centers comparing data of ALPPS and extended hepatectomy following PVE/PVL, complete tumor resection was significantly better in ALPPS with similar survival rates.…”

supporting

confidence: 50%

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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supporting

confidence: 50%

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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“…ALPPS consists of 3 major steps: stage I - portal branch occlusion and ISS; an interstage waiting period of usually 6-28 days [16,17,18,19,20,21,22]; and stage II - resection of the portally occluded, atrophic liver parts. Stage I: The surgical technique was described in detail by Schnitzbauer et al [15] and later by Alvarez et al [21] in 2013.…”

Section: Operative Techniquementioning

confidence: 99%

Animal Models for Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS): Achievements and Future Perspectives

et al. 2017

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Background: Since 2012, Associated Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been standing in the limelight of modern liver surgery and numerous questions have been raised regarding this novel approach. On the one hand, ALPPS has proved to be a valuable method in the treatment of hepatic tumors, while on the other hand, there are many controversies, such as high mortality and morbidity rates. Further surgical research is essential for a better understanding of underlying mechanisms and for enhancing patient safety. Summary: Until recently, only 8 animal models have been created with the purpose to mimic ALPPS-induced liver regeneration. From these 7 are rodent (6 rat and 1 mouse) models, while only 1 is a large animal model, which uses pigs. In case of rodent models, portal flow deprivation of 75-90% is achieved via portal vein ligation leaving only the right (20-25%) or left median (10-15%) lobes portally perfused, while liver splitting in general is carried out positioned according to the falciform ligament. As for the swine model, the left lateral and medial lobes (70-75% of total liver volume) are portally ligated, and the right lateral lobe (accounting for 20-24% of the parenchyma) is partially resected in order to reach critical liver volume. Each model is capable of reproducing the accelerated liver regeneration seen in human cases. However, all species have significantly different liver anatomy compared with the human anatomic situation, making clinical translation somewhat difficult. Key Messages: Unfortunately, there are no perfect animal models available for ALPPS research. Small animal models are inexpensive and well suited for basic research, but may only provide limited translational potential to humans. Clinically large animal models may provide more relevant data, but currently no suitable one exists.

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“…Lo que se menciona es que ALPPS es una alternativa que ofrece una mejor oportunidad de una resección completa respecto de la técnica convencional. Existen algunos estudios que han comunicado que no habría diferencias en la magnitud de la hipertrofia ni en la morbilidad postoperatoria (Shindoh et al, 2013;Schadde et al, 2014b;Alvarez et al, 2015); aunque sí en una mayor mortalidad postoperatoria. La hipertrofia del remanente con ALPPS se ha verificado en algunas series sobre el 80 % (Sala et al;Torres et al;Li et al, 2013;Nadalin et al;Schadde et al, 2014b;Alvarez et al, 2015;Lang et al); lo que puede estar asociado a diversas variables, como la co-existencia de co-morbilidades, las características del parénquima hepático, quimioterapia adyuvante, origen y extensión de la enfermedad metastásica, uso de clampeo intermitente, tiempo entre una etapa y otra, etc.…”

Section: Resultsunclassified

Asociación de Partición Hepática y Ligadura Portal para Hepatectomía por Etapas (ALPPS)

Manterola

Otzen

2017

Int. J. Morphol.

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MANTEROLA, C. & OTZEN, T.Asociación de partición hepática y ligadura portal para hepatectomía por etapas (ALPPS). Int. J. Morphol., 35(3):1083Morphol., 35(3): -1090Morphol., 35(3): , 2017. RESUMEN:La disfunción hepática postoperatoria del remanente hepático que ocurre en pacientes sometidos a grandes resecciones hepáticas, es un problema complejo y temido, dado su pronóstico incierto. La asociación de partición hepática y ligadura portal para hepatectomía por etapas (ALPPS), es un enfoque novedoso para pacientes portadores de enfermedad hepática oncológica que anteriormente eran considerados "no resecables". El procedimiento se realiza en dos etapas. La primera, comprende la ligadura de la rama derecha de la vena porta. Luego, se realiza la transección del parénquima hepático; incluyendo o no, la sección y ligadura de la vena hepática media. A continuación se empaqueta el hígado tumoral en una bolsa de polietileno y el abdomen es cerrado. La segunda etapa, se realiza 7 a 15 días después. Una vez abierto el abdomen, se retira la bolsa de polietileno; se ligan y seccionan la arteria, el conducto biliar y la vena hepática derechos; y se elimina el hígado tumoral. Pueden instalarse drenes y se procede al cierre de la laparotomía. La técnica ALPPS puede permitir entonces, la resección curativa de hígados tumorales en pacientes con lesiones considerados previamente como no resecables. El objetivo de este artículo fue describir las indicaciones y aspectos técnicos del ALPPS a propósito del primer caso realizado en nuestra ciudad, en una paciente de 47 años con un cáncer de vesícula biliar avanzado y metástasis bilobares.PALABRAS CLAVE: Neoplasia hepática; Metástasis hepáticas; Hígado metastásico; Hepatectomías; Trisegmentectomía derecha; Cáncer de la vesícula biliar; Insuficiencia hepática aguda; Ligadura de la vena porta; Regeneración hepática; ALPPS.

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Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Offers High Oncological Feasibility With Adequate Patient Safety

Cited by 143 publications

References 41 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

Animal Models for Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS): Achievements and Future Perspectives

Asociación de Partición Hepática y Ligadura Portal para Hepatectomía por Etapas (ALPPS)

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