Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure for colorectal liver metastasis

Hernandez‐Alejandro, Roberto; Ruffolo, Luis I.; Alikhanov, Ruslan; Björnsson, Bergþór; Torres, Orlando Jorge Martins; Serrablo, Alejandro

doi:10.1016/j.ijsu.2020.04.009

Cited by 14 publications

(11 citation statements)

References 68 publications

(63 reference statements)

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“…The second stage in classical two‐stage hepatectomy often cannot be performed (35.2%) due to disease progression between stages, insufficient liver regeneration or poor general conditions 19 . In the present study, the patients were not qualified for liver transplantation or single stage resection 2,4,6,20 . According to Petrowsky et al., partial transection of the liver (50%–80%) was associated with lower postoperative morbidity and mortality with the same volume of the FLR 19 .…”

Section: Discussionmentioning

confidence: 52%

“…Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) results in a greater liver hypertrophy in a shorter period of time. This procedure is indicated in patients with very small future liver remnant (FLR) or after failure of portal vein embolization 1–4 . According to the first report of the international ALPPS registry, HCC is the second most common indication and Vennarecci et al.…”

Section: Introductionmentioning

confidence: 99%

“…This procedure is indicated in patients with very small future liver remnant (FLR) or after failure of portal vein embolization. [1][2][3][4] According to the first report of the international ALPPS registry, HCC is the second most common indication and Vennarecci et al observed that HCC was the main indication for ALPPS procedure in their institution, with acceptable overall and disease-free survival. 5,6 Laparoscopic ALPPS has been performed since 2012 7 only in few centres and has shown promising results with lower morbidity rate associated to reduced surgical severity when compared with open procedure.…”

Section: Introductionmentioning

confidence: 99%

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Total robotic ALPPS approach for hepatocellular carcinoma in cirrhotic liver

Fernandes

Barros

Magistri

et al. 2021

Robotics Computer Surgery

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Background Hepatocellular carcinoma (HCC) is a common indication for associating liver partition with portal vein ligation for staged hepatectomy (ALPPS). Robotic liver resection has been done for HCC, but robotic ALPPS is a rare procedure. Methods To present three cases of totally robotic ALPPS in cirrhotic patients with HCC. Results Three cirrhotic male patients with HCC underwent ALPPS; the mean age was 54.3 years. MELD score was ≤9 and tumour size between 90 and 140 mm. The mean hypertrophy of the future liver remnant after the first stage was 77.5% and no postoperative liver failure was reported. Mean operative time of stage 1 was 7:30 h and of stage 2 was 4:37 h, without blood transfusion. The mean hospital stay for the first stage was 10 days and for the second stage was 9.3 days. No postoperative complication was recorded. Conclusions Robotic ALPPS in cirrhotic patients with HCC is safe and feasible.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Total robotic ALPPS approach for hepatocellular carcinoma in cirrhotic liver

Fernandes

Barros

Magistri

et al. 2021

Robotics Computer Surgery

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“…ALPPS is labeled as a high-risk operation due to its initially reported high morbidity and mortality [31]. However, a learning curve in ALPPS is observed, and things have gone into gradually reverse as improvement of patient selection, interstage management, and ALPPS technique [32,33]. A study of the International ALPPS Registry shows that the 90-day mortality decreases from 17 to 4% in 2015 among 437 patients from 16 centers [13].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the association liver partition and portal vein ligation for staged hepatectomy for the treatment of solitary huge hepatocellular carcinoma: a retrospective single-center study

et al. 2021

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Background The feasibility of association liver partition and portal vein ligation for staged hepatectomy (ALPPS) for solitary huge hepatocellular carcinoma (HCC, maximal diameter ≥ 10 cm) remains uncertain. This study aims to evaluate the safety and the efficacy of ALPPS for patients with solitary huge HCC. Methods Twenty patients with solitary huge HCC who received ALPPS during January 2017 and December 2019 were retrospectively analyzed. The oncological characteristics of contemporaneous patients who underwent one-stage resection and transcatheter arterial chemoembolization (TACE) were compared using propensity score matching (PSM). Results All patients underwent complete two-staged ALPPS. The median future liver remnant from the ALPPS-I stage to the ALPPS-II stage increased by 64.5% (range = 22.3–221.9%) with a median interval of 18 days (range = 10–54 days). The 90-day mortality rate after the ALPPS-II stage was 5%. The 1- and 3-year overall survival (OS) rates were 70.0% and 57.4%, respectively, whereas the 1- and 3-year progression-free survival (PFS) rates were 60.0% and 43.0%, respectively. In the one-to-one PSM analysis, the long-term survival of patients who received ALPPS was significantly better than those who received TACE (OS, P = 0.007; PFS, P = 0.011) but comparable with those who underwent one-stage resection (OS, P = 0.463; PFS, P = 0.786). Conclusion The surgical outcomes of ALPPS were superior to those of TACE and similar to those of one-stage resection. ALPPS is a safe and effective treatment strategy for patients with unresectable solitary huge HCC.

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“…When LT is not a possibility in CCA, recently emerging surgical approach 'Associating liver partition and portal vein ligation (ALPPS)' for staged hepatectomy procedure could be life-saving [13]. ALPPS has been mainly performed for colorectal liver metastasis, and results have been steadily improving with better knowledge in how to select patients and when to proceed with stage 2 surgery [14]. Another newly introduced and developing surgical approach is LT for colorectal liver cancer metastasis [15].…”

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confidence: 99%

Liver transplantation and hepatobiliary surgery in 2020

Ekser

Halazun

Petrowsky³

et al. 2020

International Journal of Surgery

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Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure for colorectal liver metastasis

Cited by 14 publications

References 68 publications

Total robotic ALPPS approach for hepatocellular carcinoma in cirrhotic liver

Total robotic ALPPS approach for hepatocellular carcinoma in cirrhotic liver

Efficacy of the association liver partition and portal vein ligation for staged hepatectomy for the treatment of solitary huge hepatocellular carcinoma: a retrospective single-center study

Liver transplantation and hepatobiliary surgery in 2020

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